2020 Volume 33 Issue 2 Pages 191-195
Diabetic ketoacidosis (DKA) is a frequent and serious complication of diabetes mellitus characterized by severe hyperglycemia, accumulation of ketone bodies, and metabolic acidosis. Metabolic acidosis during DKA consists of both high anion gap acidosis and normal anion gap acidosis. In addition, during DKA of type 1 diabetes, transient increase in urinary β2-MG, urinary NAG, and aminoaciduria occur. A 5-year-old boy consulted a previous doctor for polydipsia, polyuria, and viciousness, and was admitted to the department of pediatrics at Fujita Health University Hospital. The patient was diagnosed as DKA with the onset of type 1A diabetes. After physiological saline loading, continuous intravenous injection of insulin was started, and at 24 hours after admission, he was withdrawn from DKA. Laboratory findings on admission revealed elevated urinary β2-MG, metabolic acidosis, hypophosphatemia with low %TRP, and aminoaciduria. These were all alleviated with the treatment of DKA. Metabolic acidosis was considered to be a mixture of both high anion gap acidosis and normal anion gap acidosis. One month after onset, urinary β2-MG, %TRP, and aminoaciduria were improved. Since transient Fanconi syndrome occurs during DKA, it is necessary to consider the effects of tubular dysfunction in the evaluation of hypophosphatemia and metabolic acidosis and the selection of treatment methods.
