Medical History: A 22-year-old male who has cerebral palsy is admitted for the fourth time with similar findings. He is normal between these episodes, taking the same medications for control of his depression. There is no history of him that suggests diabetes mellitus. Acute Episode: Each episode begins with extreme agitation and an inability to sleep. Intake of sweetened soft drinks increases markedly and is accompanied by crampy lower abdominal pain.
The syndrome is not associated with the intake of alcohol or toxins. His P osm gap has not been increased. On physical examination, there were no signs of ECF volume contraction. Acetone was detected on his breath and in plasma. Laboratory Data: (plasma and Before therapy) pH 7.20 HCO3 mM 8 Anion gap mM 26 Albumin g/dl 4.1 Glucose mg/dl (mM) 92 (5) ß-hydroxybutyrate mM 4.5 L-Lactate mM 1.0 K mM 4.2 Creatinine mg/dl (µM) 1.0 (115)…
