Diabetic ketoalkalosis: a rare potentially dangerous condition in emergency endocrinology practice

Diabetic ketoalkalosis (DK) is a rare but potentially severe complication of diabetes mellitus, requiring emergency medical intervention. The main triggering factors for DK include infectious diseases, surgical procedures and trauma. The pathogenesis of DK involves processes related to reduced circulating blood volume due to persistent vomiting, leading to hydrogen ion loss and elevated blood bicarbonate levels, ultimately resulting in alkalemia. The clinical manifestations of DK resemble those of diabetic ketoacidosis (DKA), except for the presence of intractable vomiting, a symptom specific to DK patients. The diagnosis of DK is primarily confirmed through laboratory findings, including metabolic alkalosis (pH > 7,3 or blood bicarbonate > 18,0 mmol/L) and a delta ratio exceeding 2,0. Differential diagnosis should exclude classic DKA, euglycemic DKA, and hyperglycemic hyperosmolar state. The principles of intensive care for DK are similar to those for DKA and include: fluid resuscitation with isotonic crystalloid solutions to correct dehydration, electrolyte imbalance correction (primarily hypokalemia), intravenous short-acting insulin therapy. Despite its potential severity, DK can be successfully managed without serious complications or fatal outcomes if diagnosed and treated promptly and correctly.