title: Atypical diabetic ketoacidosis: case report.
abstract: BACKGROUND
  Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus and can lead to death if untreated. It is a complex metabolic state characterised by hyperglycaemia, acidosis and ketonuria. Bonsai is one of the herbal incense products that contains synthetic cannabinoid and can be easily accessible via the internet in many countries. It cannot be detected in blood and urine studies using conventional methods. Synthetic cannabinoid abuse is associated with severe side effects, including tachycardia, high blood pressure, acidosis, excess sedation and coma.
  
  
  METHODS
  A 17-year-old male patient was brought to the emergency department with sudden onset of dyspnoea. Laboratory investigations revealed hyperglycaemia, acidosis and ketonuria. He was admitted to the intensive care unit with a diagnosis of diabetic ketoacidosis. He was not considered a typical case of diabetic ketoacidosis because of the tendency to hypokalaemia, persistent tachycardia and bronchoscopic findings. We learned from his friends that he had used cannabis for a week and used bonzai on the day that he was brought to the emergency service.
  
  
  CONCLUSIONS
  Diabetic ketoacidosis with prolonged acidosis and tendency to hypokalaemia are investigated for the consumption of synthetic cannabinoids.
authors.affiliation: Division of Endocrinology and Metabolic Disorders, Department of Internal Medicine, Turgut Özal University Faculty of Medicine, Ankara, Turkey.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Demirci
authors.affiliation: Department of Internal Medicine, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Coşar
authors.affiliation: Division of Endocrinology and Metabolic Disorders, Department of Internal Medicine, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey.
authors.forename: Özcan
authors.initials: Ö
authors.lastname: Çiftçi
authors.affiliation: Division of Endocrinology and Metabolic Disorders, Department of Internal Medicine, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey.
authors.forename: Işılay Kalan
authors.initials: IK
authors.lastname: Sarı
keywords: Cannabinoids; diabetic ketoacidosis; hypokalaemia