Diabetic ketoacidosis: symptoms may be confused with hyperventilation syndrome.

Clinical bottom line (level 5)

Patients presenting with symptoms of hyperventilation syndrome may have diabetic ketoacidosis.
Blood glucose concentration and arterial pH should be checked.

Treasure et al: British Medical Journal 1987; 294: 630-630

Expires October 2003

The study

Case series with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: general hospital, UK

3 patients (aged one aged 52, one aged 24 and one aged 34, 100% female) one presented with breathlessness, panic attacks, palpitations; one with breathlessness, fainting, weight loss; one with infected leg wound and breathlessness
Cases: patients (% female, mean age ):
Controls: ?patients :

Outcomes studied:

All three patients were diagnosed with hyperventilation syndrome and two were given diazepam.
2-3 days later they all returned- one in a semiconscious state and one unconscious.

The evidence

When the patients returned, their blood glucose concentration and arterial pH were taken.
Patient 1:
- blood glucose 32.6 mmol/l
- arterial pH 7.2
Patient 2:
- blood glucose 45mmol/l
- arterial pH 6.99
Patient 3:
- blood glucose: 45 mmol/l
- arterial pH 6.75
All three patients were diagnosed with diabetic ketoacidosis and treated accordingly. All three patients recovered and remained well on insulin injections.

Comments

It is unclear how reliable these results are as the study was only a case study of three patients.

Citation

Treasure RA, Fowler PB, Millington HT, et al: Misdiagnosis of diabetic ketoacidosis as hyperventilation syndrome. British Medical Journal 1987; 294: 630-630

Contributor: Clare Wotton and Musab Hayatli, October 2000
Reviewer:

_{Clinical Question.}

_Patient	_{presenting with symptoms suggestive of hyperventilation syndrome}
_{Intervention or Exposure}	_{arterial pH; blood glucose concentration}
_Outcome	_{diabetic ketoacidosis}