A case of soft-drink ketosis concomitant with extremely elevated serum fructose concentrations

Abstract

A 17-year-old man seen for thirst and unexpected weight loss was found in laboratory examinations on admission to have plasma glucose (PG) markedly elevated to 1,107 mg/d/l and hemoglobin A1C of 13.5%, although his consciousness was alert. Serum keton body was elevated to 8,460 mug/l, while arterial pH remained within normal range i.e., 7.36. He was diagnosed with soft-drink ketosis because of a negative serum anti-GAD antibody, a habit of over drinking soft drinks and obesity (BMI 29.9). He was treated with fluids and insulin and hyperglycemia improved shortly. Serum fructose concentration extremely elevated to 517.3 mumol/l (standard range: <10 mumol/l, 1 mumol/l = 0.018 mg/dl) on admission decreased to 67.9 mumol/l (PG 330 mg/dl) 1 day and to 18.9 mumol/l(PG 218 mg/dl) 11 days after admission. The mean serum fructose concentration of patients with soft-drink ketosis (n = 3) is obviously higher than that of patients with diabetic ketoacidosis (n = 10) at admission, although mean PG was similar. Markedly elevated serum fructose concentrations may thus play an important role in the pathogenesis of soft-drink ketosis.