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Presentation of mixed diabetic ketoacidosis and metabolic acidosis due to ileal neobladder reconstruction
  1. Dileep Kumar1,
  2. Muhammad Zubair Nasim2,
  3. Bilal Ahmad Shoukat2 and
  4. Syed Shabahat Ali Shah1
  1. 1Department of Medicine and Endocrinology, Our Lady's Hospital, Navan, Co.Meath, Ireland
  2. 2Department of Medicine, Our Lady's Hospital, Navan, Co.Meath, Ireland
  1. Correspondence to Dr Dileep Kumar; keswanidileep{at}


Diabetic ketoacidosis (DKA) is one of the most serious acute metabolic complications of diabetes mellitus. It is characterised by the biochemical triad of hyperglycaemia, ketonemia/ketonuria, and an increased anion gap metabolic acidosis. In this case, a 40-year-old male patient presented to the emergency department, with vomiting, nausea, polydipsia, polyuria and weight loss. He was found to have an elevated plasma glucose, despite having no known history of diabetes mellitus. His medical history was significant for spina bifida and ileal neobladder reconstruction. The plasma glucose level was 38 mmol/L. Blood gas analysis showed normal anion gap metabolic acidosis with high chloride and low bicarbonate. His plasma ketone level was 4.5 mmol/L. No significant reason for hyperchloraemia was identified. On initiation of DKA regimen, his condition improved and serum ketones normalised. Due to persistent hyperchloraemic metabolic acidosis, bicarbonate infusion was administered and his metabolic acidosis resolved.

  • diabetes
  • endocrinology
  • fluid electrolyte and acid-base disturbances
  • urological surgery

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  • Contributors DK was involved in drafting of work, concept and design, collection and interpretation of data. MZN and BAS took part in drafting and collection of data. SSAS was involved in critical analysis and final revision of data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.