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Abstract: FR-PO580

A Case of Diabetic Ketoacidosis Concurrently with Severe Hypokalemia Induced by Distal Renal Tubular Acidosis Due to Toluene Intoxication

Session Information

  • Trainee Case Reports - III
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Aihara, Kazuki, Tokai University School of Medicine, Isehara, Kanagawa, Japan
  • Nakagawa, Yosuke, Tokai University School of Medicine, Isehara, Kanagawa, Japan
  • Hamano, Naoto, Tokai University School of Medicine, Isehara, Kanagawa, Japan
  • Koizumi, Masahiro, Tokai University School of Medicine, Isehara, Kanagawa, Japan
  • Wada, Takehiko, Tokai University, Isehara, Kanagawa, Japan
  • Fukagawa, Masafumi, Tokai University School of Medicine, Isehara, Kanagawa, Japan

Group or Team Name

  • Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
Introduction

Diabetic ketoacidosis (DKA) is a high anion gap metabolic acidosis due to excessive blood concentration of ketone bodies. Hyperkalemia is often accompanied with DKA because of extracellular potassium shift caused by lack of insulin action as well as reduced renal potassium excretion caused by acute prerenal kidney injury. Here, we report a case of DKA complicated by severe hypokalemia resulting from distal renal tubular acidosis type 1 (RTA-1) due to toluene intoxication.

Case Description

A 37-year-old male who had been treated with basal supported oral therapy for type 2 diabetes mellitus for 7 years experienced appetite loss. He took only isotonic drinks for 5 days and nausea and vomiting developed, followed by muscle weakness and difficulty of walking. He was referred to our hospital with his laboratory findings of hyperglycemia and high anion gap metabolic acidosis with ketonemia, which was diagnosed as DKA. In the meantime, normal anion gap metabolic acidosis was thought to be exist as well. In addition, he had severe hypokalemia and inappropriately high urinary excretion levels of potassium despite acute kidney injury due to volume depletion. He was treated with fluid resuscitation and continuous venous insulin infusion plus a large amount of potassium supplementation (Figure 1). After his general status improved, he stayed out of the hospital for trial. However, he came back in a haze with an odor of organic solvent and urinalysis revealed elevated levels of potassium and urinary hippuric acid concentration (23.65 g/L). Finally, he confessed to abuse of toluene for more than 20 years.

Discussion

It is known that toluene intoxication can be the cause of RTA-1 which gives rise to normal anion gap metabolic acidosis and hypokalemia. We should take toluene intoxication account if severe hypokalemia is accompanied with DKA.