Sir.—We read with interest the article by Buckingham et al (Journal 1981;135:352-354) describing the phenomenon of rhabdomyolysis in diabetic ketoacidosis. We studied a patient with very similar clinical and biochemical features.
Report of a Case.—An 11-year-old boy was admitted to this hospital with severe diabetic ketoacidosis, having been completely fit until four days earlier. At the time of admission, he was deeply comatose, with plasma glucose level of 803 mg/dL, bicarbonate level of 6 mEq/L, and an arterial blood pH of 7.0. During the first 12 hours of management, large quantities of intravenous sodium were given: as bicarbonate (60 mEq), as 0.167M sodium lactate solution, and as 0.9% sodium chloride solution 293 mM). A severe hyperosmolar state subsequently developed, with a plasma sodium level of 183 mEq/L and plasma osmolality of 394 mOsm/kg. Plasma phosphate level was diminished to 2.35 mg/dL (normal range, 3.99 to 5.51 mg/dL).