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Saudi Journal of Kidney Diseases and Transplantation
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CASE REPORT Table of Contents   
Year : 2015  |  Volume : 26  |  Issue : 3  |  Page : 580-583
Hypothermia and hypokalemia in a patient with diabetic ketoacidosis


Division of Nephrology, Department of Medicine, Jichi Medical University, Shimotuke, Japan

Correspondence Address:
Dr. Osamu Saito
Division of Nephrology, Jichi Medical University, 3311-1 Yakushiji, Simotsuke, Tochigi, 329-0498
Japan
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DOI: 10.4103/1319-2442.157387

PMID: 26022032

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We present the case of a 36-year-old man with type-1 diabetes who was hospitalized with diabetic ketoacidosis (DKA). On admission, he had hypothermia, hypokalemia and combined metabolic and respiratory alkalosis, in addition to hyperglycemia. Hypothermia, hypokalemia and metabolic alkalosis, with a concurrent respiratory alkalosis, are not commonly seen in DKA. After admission, intravenous infusion of 0.45% saline was administered, which resulted in the development of pure metabolic acidosis. After starting insulin infusion, hypokalemia and hypophosphatemia became evident and finally resulted in massive rhabdomyolysis. Hyperkalemia accompanying oliguric acute kidney injury (AKI) warranted initiation of hemodialysis (HD) on Day-five. On the 45th hospital day, his urine output started to increase and a total of 22 HD sessions were required. We believe that in this case severe dehydration, hypothermia and hypokalemia might have contributed to the initial symptoms of DKA as well as the prolongation of AKI.


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