A 17-year-old boy with a 10-year history of type 1 diabetes mellitus was admitted with
diabetic ketoacidosis after a night of binge drinking.
He was treated appropriately with a fixed-rate intravenous insulin infusion and intravenous sodium chloride 0.9%.
Twenty-four hours after admission, he was eating and drinking normally. He was taking his usual doses of subcutaneous insulin and his urinary ketones were undetectable.
Investigations (6 hours previously):
venous blood gases, breathing air:
PO25.6 kPa
PCO23.8 kPa
pH7.29
bicarbonate16 mmol/L
base excessC1 mmol/L
lactate1.1 mmol/L
What is the likely most cause of these results?
A . alcohol toxicity
B . concurrent aspirin ingestion
C . continued ketonaemia
D . hyperchloraemia
E . hyporeninaemic hypoaldosteronism
Answer: D
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