Metabolic alkalosis masked presentation of diabetic ketoacidosis: A case report

Abstract

Key Clinical Message Managing mixed acid–base disorders can be diagnostically challenging, particularly when metabolic acidosis and metabolic alkalosis occur simultaneously. When dealing with metabolic alkalosis, a comprehensive approach involves taking a detailed medical history, assessing volume status, and performing urine chloride analysis. Routine calculation of the anion gap is important to identify masked wide anion gap metabolic acidosis. We report a case of a 32‐year‐old female with type 1 diabetes mellitus, presented with intractable vomiting for 2 days with hyperglycemia, hypokalemia, and metabolic alkalosis, along with a wide anion gap. She was diagnosed with “diabetic ketoalkalosis” due to diabetic ketoacidosis combined with vomiting‐induced metabolic alkalosis. She became clinically stable after resuscitation with normal saline, intravenous potassium, and intravenous insulin.

Keywords

• diabetic ketoacidosis
• gastric alkalosis
• ketoalkalosis
• metabolic alkalosis