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Shivani Patel, Venessa Chin, and Jerry R Greenfield

.1 mmol/L, pH: 7.14, bicarbonate: 11.2 mmol/L and serum beta hydroxybutyrate: >8.0 mmol/L. She was otherwise haemodynamically stable with a normal clinical examination. Investigation Initial HbA1c on admission was elevated at 7.8%. She was

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Sarah Kiff, Carolyn Babb, Maria Guemes, Antonia Dastamani, Clare Gilbert, Sarah E Flanagan, Sian Ellard, John Barton, M Dattani, and Pratik Shah

). Table 1 Day 3 and day 31 hypoglycaemia screens: showing inappropriately elevated insulin concentration in the context of hypoglycaemia, without mobilisation of non-esterified fatty acids and beta-hydroxybutyrate production. Consistent with diagnosis

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Dinesh Giri, Prashant Patil, Rachel Hart, Mohammed Didi, and Senthil Senniappan

plasma insulin concentration was inappropriately elevated at 12.8 µIU/L and C-peptide of 220 ng/mL during hypoglycaemia (blood glucose 1.0 mmol/L). The plasma free fatty acids (447 μmol/L) and 3-hydroxybutyrate (29 μmol/L) were inappropriately suppressed

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Gordon Sloan, Amjad Ali, and Jonathan Webster

pelvis were normal. An admission venous blood gas revealed severe metabolic acidosis: pH 7.021 and bicarbonate 5.1 mmol/L (22–29 mmol/L). The anion gap was 37 mmol/L. The capillary blood 3-hydroxybutyrate (Abbott Freestyle Precision Pro) was 5.4 mmol

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Gordon Sloan, Tania Kakoudaki, and Nishant Ranjan

quadrant tenderness with no peritonism. Investigation An electrocardiogram revealed antereo-lateral ST segment depression. Finger prick blood glucose was 13.3 mmol/L and 3-hydroxybutyrate 5.2 mmol/L. Venous blood glucose was determined; pH: 7.15 and

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Ming Li Yee, Rosemary Wong, Mineesh Datta, Timothy Nicholas Fazio, Mina Mohammad Ebrahim, Elissa Claire Mcnamara, Gerard De Jong, and Christopher Gilfillan

decarboxylase antibody (units/mL) <0.6 <5.0 Brain MRI showed global cerebral atrophy and small vessel ischemic changes. Treatment An insulin infusion was commenced resulting in normalization of glucose, beta hydroxy-butyrate, lactate

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Clarissa Ern Hui Fang, Mohammed Faraz Rafey, Aine Cunningham, Sean F Dinneen, and Francis M Finucane

normal. He was obese with a BMI of 33.2 kg/m 2 . He had subtle axillary acanthosis nigricans. Investigation At presentation, the patient had a markedly elevated blood glucose and beta-hydroxybutyrate, with very low bicarbonate, as shown in Table

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Jose León Mengíbar, Ismael Capel, Teresa Bonfill, Isabel Mazarico, Laia Casamitjana Espuña, Assumpta Caixàs, and Mercedes Rigla

increased anion gap metabolic acidosis (pH: 7.13, HCO 3 − : 11.9 mEq/L, anion gap: 21 mEq/L) associated with ketosis (beta-hydroxybutyrate in capillary blood: 6.0 mmol/L). Other metabolic derangements (hyponatraemia and hyperkalaemia) were related to DKA

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Sebastian Hörber, Sarah Hudak, Martin Kächele, Dietrich Overkamp, Andreas Fritsche, Hans-Ulrich Häring, Andreas Peter, and Martin Heni

screening was negative except for benzodiazepines. Serum beta-hydroxybutyrate was elevated and HbA1c was 12.2% (110 mmol/mol). C-peptide was decreased (77 pmol/L). Figure 1 Arterial blood gas analysis. (A) Time course of the pH measurements for the

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Ved Bhushan Arya, Jennifer Kalitsi, Ann Hickey, Sarah E Flanagan, and Ritika R Kapoor

examination was unremarkable. Investigations A hypoglycaemia screen confirmed the diagnosis of HH (BG 2.6 mmol/L, serum insulin 40.3 mIU/L, non-esterified fatty acids 0.10 mmol/L, β-hydroxybutyrate <0.10 mmol/L). All other investigations including