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Metabolic Alkalosis in Diabetic Ketosis

José A. Jiménez, MD; Antonio Damiano, MD; Elvira Fernández, MD; Frederico Rodríguez-Rubio, MD; Miguel Garrido, MD
JAMA. 1975;233(11):1193-1194. doi:10.1001/jama.1975.03260110051022.
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THE OVERPRODUCTION of ketone bodies during the uncontrolled metabolic state in certain diabetic patients ordinarily leads to an accumulation of hydrogen ions and acidosis. Nevertheless, a coincidental condition, usually protracted vomiting, may result in the excessive loss of H+. The consequence would, then, be the appearance of metabolic alkalosis in the presence of diabetic ketosis.1,2

Report of a Case  A 58-year-old diabetic woman who had been taking tolbutamide, 0.5 gm three times a day, was admitted to the University Hospital M. Mora on Dec 14,1972, in a comatose state.Three weeks before admission, she had stopped taking the medication because she "got tired of taking pills." Ten days later, she experienced malaise, severe polyuria, diffuse abdominal pain with nausea, and at times, vomiting. She had no fever and there were no symptoms of urinary involvement. Her condition deteriorated, and four days before admission, the vomiting became frequent, the polyuria


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