Pancreatic ketoacidosis-a rare case report

Euglycemic Pancreatic Ketoacidosis is a syndrome of high anion gap acidosis in which the high anion gap is due to elevated serum ketone bodies comprising of acetone, aceto- acetate and beta hydroxyl-butyrate, due to increased peripheral adipose tissue breakdown by elevated serum lipase as a consequence of acute pancreatitis with normal blood glucose levels. There are multiple causes for ketonuria and/or ketonemia with or without acidosis like uncontrolled diabetes mellitus, usually of the insulin dependent type (diabetic ketoacidosis), lactic acidosis, prolonged starvation (starvation ketosis), ethanol ingestion (alcoholic ketoacidosis), sepsis, pregnancy and vomiting. Our patient was not a known diabetic and his blood glucose were always within normal limits, so this ketoacidosis cannot be attributed to Diabetes Mellitus. It cannot be attributed to starvation as our patient was not fasting when he got admitted and furthermore ketoacidosis is not a frequent manifestation of starvation adding to it that we transfused adequate amount of DNS and resumed oral intake during our observation period. It cannot be attributed to vomiting as our patient had only two episodes of vomiting. Our patient does not have any liver or kidney pathology and there is no history or evidence of alcohol intoxication. But, acute pancreatitis without diabetes-mellitus, causing ketoacidosis is a very rare presentation which is caused by high levels of pancreatic lipase in the circulation.

Serum Electrolyte and Acid Base Composition in Patients with Graded Degrees of Chronic Renal Failure

One hundred sixty-three patients with graded degrees of uncomplicated stable chronic renal failure were studied to investigate the quantitative relationship between serum acid-base and electrolyte composition and serum creatinine level. Even in patients with a mild degree of renal failure, the serum total carbon dioxide (tCO2) content was reduced significantly. Progressive decrements in tCO2 were noted in the more severe degrees of renal failure with the reciprocal relationship between tCO2 and serum creatinine concentration. Depending upon the degree of chronic renal failure, the type of metabolic acidosis was different. In patients with a moderate degree of renal failure, hyperchloremic acidosis was noted with anion gap remaining normal. As the renal failure progressed to a more severe degree, this pattern of hyperchloremic acidosis changed to anion gap acidosis with a normal serum chloride level. The highest anion gap was 25 mEq/L in the patient with serum creatinine concentration 24.7mg/dL.