Department of Internal Medicine, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
BMC Endocr Disord. 2022 Jun 2;22(1):148. doi: 10.1186/s12902-022-01037-z.
Diabetic ketoacidosis (DKA) is a complication of diabetes presenting with high anion gap metabolic acidosis. Methanol poisoning, on the other hand, is a toxicology emergency which presents with the same feature. We present a case of methanol poisoning who presented with DKA.
A 28-year-old male was referred to us with blurred vision and loss of consciousness three days after ingestion of 1.5 L of an unknown mixture of bootleg alcoholic beverage. He had history of insulin-dependent diabetes and had neglected his insulin shots on the day prior to hospital admission due to progressive loss of consciousness. Vital signs were normal and venous blood gas analysis showed severe metabolic acidosis and a methanol level of 10.2 mg/dL. After eight hours of hemodialysis, he remained unresponsive. Diabetic ketoacidosis was suspected due to positive urine ketone and blood sugar of 411 mg/dL. Insulin infusion was initiated which was followed by full awakening and extubation. He was discharged completely symptom-free after 4 weeks.
Diabetic ketoacidosis and methanol poisoning can happen simultaneously in a diabetic patient. Given the analogous high anion gap metabolic acidosis, physicians should pay particular attention to examination of the diabetic patients. Meticulous evaluation for both conditions is highly recommended.
糖尿病酮症酸中毒（DKA）是糖尿病的一种并发症，表现为高阴离子间隙代谢性酸中毒。甲醇中毒则是一种毒理学急症，也具有同样的特征。我们报告了一例以 DKA 为表现的甲醇中毒患者。
一名 28 岁男性，因摄入 1.5 升未知混合自制酒类三天后出现视力模糊和意识丧失，被转至我们医院。他有胰岛素依赖型糖尿病病史，在入院前一天因逐渐意识丧失而停止注射胰岛素。生命体征正常，静脉血气分析显示严重代谢性酸中毒和 10.2mg/dL 的甲醇水平。经过八小时血液透析后，他仍未苏醒。由于尿酮阳性和血糖为 411mg/dL，故怀疑为糖尿病酮症酸中毒。开始给予胰岛素输注，随后患者完全苏醒并拔管。四周后患者完全无症状出院。
糖尿病酮症酸中毒和甲醇中毒可同时发生在糖尿病患者中。鉴于类似的高阴离子间隙代谢性酸中毒，医生应特别注意对糖尿病患者的检查。强烈建议对这两种情况进行细致的评估。
