Abstract
Our patient was a 44-year-old man who drank 4 l of soft-drinks per day. He developed consciousness disturbance after experiencing general malaise for a period of 2 weeks and was transported to our hospital. The laboratory tests on admission revealed the following: blood glucose, 1500 mg/dl; HbA1c, 12.3 %; pH, 7.143; PCO2, 27.5 mmHg; HCO3-, 9.1 mmol/l; Na, 144 mEq/l; K, 4.4 mEq/l; serum osmolality, 408 mOsm/kg H2O, metabolic acidosis and a high ketone level. He was diagnosed with diabetic ketoacidosis and was treated with a transfusion and insulin. The patient's blood glucose levels returned to normal and his acidosis improved, but the dehydration and hypernatremia persisted. A brain MRI and hypertonic saline test showed that the patient was suffering from partial central diabetes insipidus. This finding suggested that the patient's dehydration, hyperglycemia, and the increase in his plasma osmotic pressure had been caused by the excessive intake of glucose-containing drinks. Further dehydration, hyperglycemia, and serious hyperosmolality developed due to coexisting diabetes insipidus, which impaired the additional secretion of anti-diuretic hormone, leading to diabetic ketoacidosis.
