{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:16Z","timestamp":1784557036671,"version":"3.55.0"},"reference-count":26,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2018,9,24]],"date-time":"2018-09-24T00:00:00Z","timestamp":1537747200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/deed.en_GB"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,9,24]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Diabetic ketoacidosis is a life-threatening complication of diabetes mellitus. It usually occurs in patients with type 1 diabetes where it is typically associated with only moderately increased blood glucose. Here, we report the case of a 52-year-old female patient who was admitted to the emergency unit with severely altered mental status but stable vital signs. Laboratory results on admission revealed very high blood glucose (1687\u2009mg\/dL\/93.6\u2009mmol\/L) and severe acidosis (pH &lt;7) with proof of ketone bodies in serum and urine. Past history revealed a paranoid schizophrenia diagnosed 10 years ago and for which the patient was treated with risperidone for many years. Acute treatment with intravenous fluids, intravenous insulin infusion and sodium bicarbonate improved the symptoms. Further laboratory investigations confirmed diagnosis of autoimmune type 1 diabetes. After normalization of blood glucose levels, the patient could soon be discharged with a subcutaneous insulin therapy.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Learning points:<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Diabetic ketoacidosis as first manifestation of type 1 diabetes can occur with markedly elevated blood glucose concentrations in elder patients.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Atypical antipsychotics are associated with hyperglycemia and an increased risk of new-onset diabetes.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>First report of risperidone-associated diabetic ketoacidosis in new-onset type 1 diabetes.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Patients treated with atypical antipsychotics require special care and regular laboratory examinations to detect hyperglycemia and diabetic ketoacidosis.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>In cases when the diagnosis is in doubt, blood gas analysis as well as determination of C-peptide and islet autoantibodies can help to establish the definite diabetes type.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-18-0094","type":"journal-article","created":{"date-parts":[[2018,9,25]],"date-time":"2018-09-25T11:45:22Z","timestamp":1537875922000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":2,"title":["Unusual high blood glucose in ketoacidosis as first presentation of type 1 diabetes mellitus"],"prefix":"10.1530","volume":"2018","author":[{"given":"Sebastian","family":"H\u00f6rber","sequence":"first","affiliation":[{"name":"1Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, Department of Internal Medicine, University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"2Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"3German Center for Diabetes Research (DZD), M\u00fcnchen-Neuherberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Hudak","sequence":"additional","affiliation":[{"name":"1Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, Department of Internal Medicine, University of T\u00fcbingen, T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"K\u00e4chele","sequence":"additional","affiliation":[{"name":"4Department of Internal Medicine, Medical Intensive Care Unit, University of T\u00fcbingen, T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dietrich","family":"Overkamp","sequence":"additional","affiliation":[{"name":"1Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, Department of Internal Medicine, University of T\u00fcbingen, T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Fritsche","sequence":"additional","affiliation":[{"name":"1Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, Department of Internal Medicine, University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"2Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"3German Center for Diabetes Research (DZD), M\u00fcnchen-Neuherberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Ulrich","family":"H\u00e4ring","sequence":"additional","affiliation":[{"name":"1Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, Department of Internal Medicine, University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"2Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"3German Center for Diabetes Research (DZD), M\u00fcnchen-Neuherberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Peter","sequence":"additional","affiliation":[{"name":"1Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, Department of Internal Medicine, University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"2Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"3German Center for Diabetes Research (DZD), M\u00fcnchen-Neuherberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Heni","sequence":"additional","affiliation":[{"name":"1Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, Department of Internal Medicine, University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"2Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"3German Center for Diabetes Research (DZD), M\u00fcnchen-Neuherberg, 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