{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:13:32Z","timestamp":1788243212701,"version":"build-2803163510"},"reference-count":34,"publisher":"Bioscientifica","issue":"1","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":165,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Hepatogenous diabetes, a secondary form of diabetes arising from chronic liver disease, particularly cirrhosis, is a well-documented complication. However, diabetic ketoacidosis (DKA) in the context of hepatogenous diabetes has not been reported in the literature. We report the case of a 60-year-old male with alcoholic liver cirrhosis and no prior history of diabetes who presented with altered mental status and was diagnosed with DKA. Initial lab tests revealed severe hyperglycemia, high-anion gap metabolic acidosis, and an elevated HbA1C of 10.2%, a significant increase from 5.2% five months earlier. The patient was managed with insulin and lactulose, resulting in clinical improvement. Follow-up revealed normalization of HbA1C and a reduction in insulin requirements. This is the first documented case of DKA as the initial presentation of hepatogenous diabetes, emphasizing the need for heightened awareness and further research into its clinical manifestations and management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key clinical messages<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1530\/edm-25-0088","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T10:21:50Z","timestamp":1771323710000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":1,"title":["Diabetic ketoacidosis as the initial presentation of hepatogenous diabetes: a first reported case"],"prefix":"10.1530","volume":"2026","author":[{"given":"Mhd","family":"Kutaiba Albuni","sequence":"first","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahem","family":"Abbarh","sequence":"additional","affiliation":[{"name":"2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noheir","family":"Ashraf Ibrahem Fathy Hassan","sequence":"additional","affiliation":[{"name":"3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bisher","family":"Sawaf","sequence":"additional","affiliation":[{"name":"4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4019-1185","authenticated-orcid":true,"given":"Ashraf I","family":"Ahmed","sequence":"additional","affiliation":[{"name":"5"},{"name":"6"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuf","family":"Hallak","sequence":"additional","affiliation":[{"name":"4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muaataz","family":"Azzawi","sequence":"additional","affiliation":[{"name":"7"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"2026070713535616400_bib1","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1007\/s00424-020-02417-x","article-title":"Glucose transporters in adipose tissue, liver, and skeletal muscle in metabolic health and disease","volume":"472","author":"Chadt","year":"2020","journal-title":"Pfl\u00fcgers Archiv"},{"key":"2026070713535616400_bib2","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/S1521-690X(03)00031-9","article-title":"Hepatic glucose metabolism in humans \u2013 its role in health and disease","volume":"17","author":"Roden","year":"2003","journal-title":"Best Pract Res Clin Endocrinol Metabol"},{"key":"2026070713535616400_bib3","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/S0168-8278(96)80154-1","article-title":"Liver cirrhosis and diabetes mellitus","volume":"24","author":"del Olmo","year":"1996","journal-title":"J Hepatol"},{"key":"2026070713535616400_bib4","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1002\/hep.510310320","article-title":"Contribution of reduced insulin sensitivity and secretion to the pathogenesis of hepatogenous diabetes: effect of liver transplantation","volume":"31","author":"Perseghin","year":"2000","journal-title":"Hepatology"},{"key":"2026070713535616400_bib5","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/S0140-6736(77)91652-X","article-title":"Hyperinsulinism of hepatic cirrhosis: diminished degradation or hypersecretion?","volume":"1","author":"Johnson","year":"1977","journal-title":"Lancet"},{"key":"2026070713535616400_bib6","article-title":"Adult diabetic ketoacidosis","volume-title":"StatPearls [Internet]","author":"Lizzo","year":"2025"},{"key":"2026070713535616400_bib7","doi-asserted-by":"crossref","first-page":"552","DOI":"10.4103\/ijem.IJEM_79_18","article-title":"Hepatogenous diabetes: an underestimated problem of liver cirrhosis","volume":"22","author":"Kumar","year":"2018","journal-title":"Indian J Endocrinol Metab"},{"key":"2026070713535616400_bib8","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1080\/1744666X.2019.1601014","article-title":"Guselkumab for the treatment of adults with moderate to severe plaque psoriasis","volume":"15","author":"Puig","year":"2019","journal-title":"Expet Rev Clin Immunol"},{"key":"2026070713535616400_bib9","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1080\/14740338.2023.2223956","article-title":"Adverse events of guselkumab in the real world: emerging signals to target preventive strategies from the FDA adverse event reporting system","volume":"22","author":"Xiang","year":"2023","journal-title":"Expet Opin Drug Saf"},{"key":"2026070713535616400_bib10","doi-asserted-by":"crossref","first-page":"855","DOI":"10.36849\/JDD.6216","article-title":"Serious gastrointestinal-related adverse events among psoriasis patients treated with Guselkumab in VOYAGE 1 and VOYAGE 2","volume":"20","author":"Foley","year":"2021","journal-title":"J Drugs Dermatol"},{"key":"2026070713535616400_bib11","first-page":"S12","article-title":"The role of IL-23 and the use of IL-23 inhibitors in psoriatic arthritis","volume":"20","author":"Fragoulis","year":"2022","journal-title":"Muscoskel Care"},{"key":"2026070713535616400_bib12","volume-title":"StatPearls","author":"Ellis","year":"2023"},{"key":"2026070713535616400_bib13","doi-asserted-by":"crossref","first-page":"7","DOI":"10.4103\/WKMP-0110.170765","article-title":"Adalimumab","volume":"1","author":"Rambhia","year":"2015","journal-title":"Indian J Drugs Dermatol"},{"key":"2026070713535616400_bib14","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1002\/acr2.11124","article-title":"Comparative risk of diabetes mellitus in patients with rheumatoid arthritis treated with biologic or targeted synthetic disease-modifying drugs: a cohort study","volume":"2","author":"Desai","year":"2020","journal-title":"ACR Open Rheumatol"},{"key":"2026070713535616400_bib15","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1007\/s40264-022-01210-2","article-title":"Anti-tumor necrosis factor-alpha therapy and hypoglycemia: a real-world pharmacovigilance analysis","volume":"45","author":"Zhou","year":"2022","journal-title":"Drug Saf"},{"key":"2026070713535616400_bib16","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1001\/archderm.144.10.1403","article-title":"Recurrent hyperglycemia during adalimumab treatment in a patient with psoriasis","volume":"144","author":"Wu","year":"2008","journal-title":"Arch Dermatol"},{"key":"2026070713535616400_bib17","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.bpg.2011.02.009","article-title":"Liver cirrhosis","volume":"25","author":"Pinzani","year":"2011","journal-title":"Best Pract Res Clin Gastroenterol"},{"key":"2026070713535616400_bib18","doi-asserted-by":"crossref","first-page":"1978","DOI":"10.1016\/j.cgh.2023.04.015","article-title":"The global burden of liver disease","volume":"21","author":"Younossi","year":"2023","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2026070713535616400_bib19","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1097\/MCG.0000000000000208","article-title":"The epidemiology of cirrhosis in the United States: a population-based study","volume":"49","author":"Scaglione","year":"2015","journal-title":"J Clin Gastroenterol"},{"key":"2026070713535616400_bib20","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.4254\/wjh.v14.i7.1291","article-title":"Hepatogenous diabetes: knowledge, evidence, and skepticism","volume":"14","author":"Kumar","year":"2022","journal-title":"World J Hepatol"},{"key":"2026070713535616400_bib21","doi-asserted-by":"crossref","first-page":"81321","DOI":"10.18632\/oncotarget.18466","article-title":"Association of type 2 diabetes with liver cirrhosis: a nationwide cohort study","volume":"8","author":"Hsieh","year":"2017","journal-title":"Oncotarget"},{"key":"2026070713535616400_bib22","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/1471-230X-10-56","article-title":"Nine-year incident diabetes is predicted by fatty liver indices: the French D.E.S.I.R. study","volume":"10","author":"Balkau","year":"2010","journal-title":"BMC Gastroenterol"},{"key":"2026070713535616400_bib23","first-page":"455","article-title":"Impact of liver disease severity and etiology on the occurrence of diabetes mellitus in patients with liver cirrhosis","volume":"51","author":"Petit","year":"2014","journal-title":"Acta Diabetol"},{"key":"2026070713535616400_bib24","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1111\/liv.13115","article-title":"Diabetes mellitus in patients with cirrhosis: clinical implications and management","volume":"36","author":"Elkrief","year":"2016","journal-title":"Liver Int"},{"key":"2026070713535616400_bib25","doi-asserted-by":"crossref","first-page":"5063","DOI":"10.1172\/JCI137556","article-title":"Hypoxia-inducible factors and diabetes","volume":"130","author":"Gunton","year":"2020","journal-title":"J Clin Invest"},{"key":"2026070713535616400_bib26","doi-asserted-by":"crossref","DOI":"10.1038\/srep10949","article-title":"Higher plasma betatrophin\/ANGPTL8 level in type 2 diabetes subjects does not correlate with blood glucose or insulin resistance","volume":"5","author":"Abu-Farha","year":"2015","journal-title":"Sci Rep"},{"key":"2026070713535616400_bib27","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.clnesp.2024.02.013","article-title":"Glucose turnover at whole-body and skeletal muscle level in response to parenteral nutrition in male patients with alcoholic liver cirrhosis","volume":"60","author":"Trinh","year":"2024","journal-title":"Clin Nutr ESPEN"},{"key":"2026070713535616400_bib28","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.1016\/j.jhep.2015.08.011","article-title":"Contribution of \u03b2-cell dysfunction and insulin resistance to cirrhosis-associated diabetes: role of severity of liver disease","volume":"63","author":"Grancini","year":"2015","journal-title":"J Hepatol"},{"key":"2026070713535616400_bib29","article-title":"A case of hyperglycemic ketoacidosis in a patient without diabetes","volume":"14","author":"Aung","year":"2022","journal-title":"Cureus"},{"key":"2026070713535616400_bib30","article-title":"A case of new onset diabetes and severe diabetes ketoacidosis in a patient with COVID-19","volume":"13","author":"Patel","year":"2021","journal-title":"Cureus"},{"key":"2026070713535616400_bib31","doi-asserted-by":"crossref","first-page":"3","DOI":"10.37796\/2211-8039.1389","article-title":"New-onset diabetes in COVID-19: the molecular pathogenesis","volume":"13","author":"Wihandani","year":"2023","journal-title":"Biomedicine"},{"key":"2026070713535616400_bib32","doi-asserted-by":"crossref","first-page":"729","DOI":"10.4239\/wjd.v13.i9.729","article-title":"COVID-19 associated diabetes mellitus: a review","volume":"13","author":"Gavkare","year":"2022","journal-title":"World J Diabetes"},{"key":"2026070713535616400_bib33","doi-asserted-by":"crossref","first-page":"307","DOI":"10.4254\/wjh.v8.i6.307","article-title":"Bacterial infections in cirrhosis: a critical review and practical guidance","volume":"8","author":"Bunchorntavakul","year":"2016","journal-title":"World J Hepatol"},{"key":"2026070713535616400_bib34","doi-asserted-by":"crossref","first-page":"254","DOI":"10.4254\/wjh.v10.i2.254","article-title":"Spontaneous bacterial and fungal peritonitis in patients with liver cirrhosis: a literature review","volume":"10","author":"Shizuma","year":"2018","journal-title":"World J Hepatol"}],"container-title":["Endocrinology, Diabetes &amp; Metabolism Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2026\/1\/EDM-25-0088.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2026\/1\/EDM-25-0088.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/journals.bioscientifica.com\/edm\/article-pdf\/doi\/10.1530\/EDM-25-0088\/504756\/edm-25-0088.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/journals.bioscientifica.com\/edm\/article-pdf\/doi\/10.1530\/EDM-25-0088\/504756\/edm-25-0088.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T17:54:16Z","timestamp":1783446856000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.bioscientifica.com\/edm\/article\/2026\/1\/EDM250088\/75395\/Diabetic-ketoacidosis-as-the-initial-presentation"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,1]]},"references-count":34,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.1530\/edm-25-0088","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,1]]},"article-number":"EDM250088"}}