Abstract
A 36-year-old woman was admitted to our hospital with complaints of vomiting and drowsiness after a one-week history of drinking only alcohol, without any meal intake. We diagnosed her with diabetic ketoacidosis and started a continuous intravenous insulin infusion, which resulted in severe hypokalemia, from 2.7 mEq/l to 1.3 mEq/l, requiring discontinuation of the insulin infusion. A total of 660 mEq of potassium infusion for the first 72 hours was required to maintain a normal serum K level. The ketoacidosis recovered; however, severe acidemia remained. Using a Stewart's physicochemical acid-base analysis, we found that the main cause of the acidosis was strong ion-derived acidosis brought about by the presence of excess free water, massive saline infusion, tubular damage and excessive loss of ketone bodies. The primary cause of the severe hypokalemia in the present case was the depletion of total body potassium, which may have been closely related to the patient's eating disorder. Furthermore, these conditions caused the depletion of other electrolytes, including calcium, phosphorus and magnesium. A more detailed analysis of acid-base abnormalities and electrolyte disturbances is required in such patients, including physicochemical analyses.
