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Diabetic ketoalkalosis: misnomer or undiagnosed variant of diabetic ketoacidosis
  1. Sushant Nanavati,
  2. Vinod Kumar,
  3. Gabriel Melki,
  4. Monisha Singhal
  1. Department of Internal Medicine, St Joseph’s University Medical Center, Paterson, New Jersey, USA
  1. Correspondence to Dr Sushant Nanavati, snanav2{at}


Usually, hyperglycaemia crisis presents with acidotic pH, but ketoalkalosis is a rare and unheard entity presenting in diabetic ketoacidosis. We describe three unique cases where the patients present with hyperglycaemia >250 mg/dL, normal or alkalotic pH, and bicarbonate >20 meq/L, which does not meet criteria for diabetic ketoacidosis. However, once these patients were supplemented with intravenous fluids, diagnosis of diabetic ketoacidosis was evident in laboratory analysis. These case series provide a learning opportunity in diagnosing and management of this rare phenomenon.

  • diabetes
  • metabolic disorders
  • adult intensive care
  • fluid electrolyte and acid-base disturbances
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  • Contributors SN, VK, GM: contributions in the manuscript for the introduction, case presentation and discussion. MS: mentor guiding in writing the case and discussion.

  • 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 Obtained.

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

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