Metabolic acidosis mimicking diabetic ketoacidosis after use of calorie-free mineral water

A previously healthy boy was admitted with fever, tachycardia, dyspnea, and was vomiting. A blood test showed a severe metabolic acidosis with pH 7.08 and an anion gap of 36 mmol/L. His urine had an odor of acetone. The serum glucose was 5.6 mmol/L, and no glucosuria was found. Diabetic ketoacidosis...

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Bibliographic Details
Published in:European journal of pediatrics 2012-09, Vol.171 (9), p.1405-1407
Main Authors: Dahl, Gry T., Woldseth, Berit, Lindemann, Rolf
Format: Article
Language:English
Subjects:
Acidosis
Biological and medical sciences
Calories
Carbonated Beverages
Cardiac arrhythmia
Case Report
Case reports
Child, Preschool
Children & youth
Diabetes
Diabetes. Impaired glucose tolerance
Diabetic ketoacidosis
Diabetic Ketoacidosis - diagnosis
Diagnosis, Differential
Drinking Water
Dyspnea
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Fever
General aspects
Glucose
Hospitals
Humans
Hyperglycemia
Ketosis
Ketosis - diagnosis
Ketosis - etiology
Male
Medical sciences
Medicine
Medicine & Public Health
Metabolic disorders
Mineral water
Pediatrics
Potassium
Production increases
Starvation - complications
Stomatitis, Herpetic - complications
Sweetening Agents
Urine
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Summary:A previously healthy boy was admitted with fever, tachycardia, dyspnea, and was vomiting. A blood test showed a severe metabolic acidosis with pH 7.08 and an anion gap of 36 mmol/L. His urine had an odor of acetone. The serum glucose was 5.6 mmol/L, and no glucosuria was found. Diabetic ketoacidosis could therefore be eliminated. Lactate level was normal. Tests for the most common metabolic diseases were negative. Because of herpes stomatitis, the boy had lost appetite and only been drinking Diet Coke and water the last days. Diet Coke or Coca-Cola Light is sweetened with a blend containing cyclamates, aspartame, and acesulfame potassium, all free of calories. The etiology of the metabolic acidosis appeared to be a catabolic situation exaggerated by fasting with no intake of calories. The elevated anion gap was due to a severe starvation ketoacidosis, mimicking a diabetic ketoacidosis. Pediatricians should recommend carbohydrate/calorie-containing fluids for rehydration of children with acute fever, diarrhea, or illness.
ISSN:0340-6199
1432-1076
DOI:10.1007/s00431-012-1723-7