Ketogenic Diet as a Trigger for Diabetic Ketoacidosis in a Misdiagnosis of Diabetes: A Case Report
Abstract
A 30-year-old Caucasian man with a 2-month history of type 2 diabetes presented to the emergency department with abdominal pain, emesis with occasional coffee-ground content, and constipation of 6 days’ duration. The day before, he had presented to an urgent care center for similar complaints and was told he had a high stool burden and was prescribed an oral laxative, which he was unable to tolerate.
He was taking metformin 1,000 mg twice daily for type 2 diabetes and had also initiated lifestyle modifications, which included an intensive low-carbohydrate ketogenic diet. He had restricted his carbohydrate intake to no more than 20 g/day. His family history included type 2 diabetes in his father and type 1 diabetes in a grandparent. He reported having lost 60 lb during the past 2 months, and his current weight was 263 lb (BMI 33.5 kg/m2). Previous lipid panels were only significant for low HDL cholesterol of 33 mg/dL. Since his diabetes diagnosis, home monitoring had revealed blood glucose fluctuations between 90 and 400 mg/dL despite changes in activity and diet and initiation of medication.
His vital signs included blood pressure 159/100 mmHg, pulse 98 bpm, respiration rate 26/minutes with noted Kussmaul breathing, oxygen saturation 99%, and temperature 98.1°F. Physical examination revealed diffuse abdominal tenderness, dry mucous membranes, and an acetone-like scent on his breath. Further testing revealed the results shown in Table 1, which included positive urine ketones…
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