Misdiagnosis of diabetic ketoacidosis: a case report

Abstract Background Abdominal pain caused by diabetic ketoacidosis is uncommon and can easily be misdiagnosed as abdominal pain caused by ureteral stones.This case highlights the importance of distinguishing between these etiologies, particularly in patients with diabetes, as delayed recognition of...

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Main Authors: Minghe Zhang, Jian Li, Lianhui Fan, Hongtao Liu
Format: Article
Language:English
Published: BMC 2025-08-01
Series:Journal of Medical Case Reports
Subjects:
Online Access:https://doi.org/10.1186/s13256-025-05478-7
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author Minghe Zhang
Jian Li
Lianhui Fan
Hongtao Liu
author_facet Minghe Zhang
Jian Li
Lianhui Fan
Hongtao Liu
author_sort Minghe Zhang
collection DOAJ
description Abstract Background Abdominal pain caused by diabetic ketoacidosis is uncommon and can easily be misdiagnosed as abdominal pain caused by ureteral stones.This case highlights the importance of distinguishing between these etiologies, particularly in patients with diabetes, as delayed recognition of diabetic ketoacidosis can result in life-threatening complications. The novelty lies in emphasizing the diagnostic challenges and the necessity for clinicians to consider diabetic ketoacidosis even when imaging suggests alternative causes. Case presentation This case report describes a 59-year-old Han female patient who was admitted to the hospital for "generalized abdominal pain without obvious cause for 3 days" and was diagnosed with left ureteral stones. Initial imaging revealed a left ureteral stone and hydronephrosis, prompting ureteral stent placement. Despite antispasmodics, analgesics, and stent insertion, her pain persisted. Diabetic ketoacidosis was subsequently confirmed through laboratory tests. Following comprehensive systemic treatment, metabolic parameters were successfully normalized, and the patient recovered and was discharged from the hospital. Conclusion The mechanisms and treatment approaches for abdominal pain caused by ketoacidosis and ureteral stones differ significantly. Clinicians treating abdominal pain in patients with a history of diabetes should consider the possibility of ketoacidosis-induced abdominal pain, especially when conventional antispasmodic and analgesic treatments for ureteral stones are ineffective. Prompt identification of diabetic ketoacidosis via comprehensive clinical assessment and laboratory investigations is crucial to avoid delays in appropriate treatment. Enhanced recognition of the overlapping symptoms between diabetic ketoacidosis and ureteral stones can minimize diagnostic errors and lead to better patient outcomes.
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spelling doaj-art-e2b2fb64f33d4df29a809fb2b09f84072025-08-20T03:44:01ZengBMCJournal of Medical Case Reports1752-19472025-08-011911510.1186/s13256-025-05478-7Misdiagnosis of diabetic ketoacidosis: a case reportMinghe Zhang0Jian Li1Lianhui Fan2Hongtao Liu3General Hospital of Northern Theater CommandGeneral Hospital of Northern Theater CommandGeneral Hospital of Northern Theater CommandGeneral Hospital of Northern Theater CommandAbstract Background Abdominal pain caused by diabetic ketoacidosis is uncommon and can easily be misdiagnosed as abdominal pain caused by ureteral stones.This case highlights the importance of distinguishing between these etiologies, particularly in patients with diabetes, as delayed recognition of diabetic ketoacidosis can result in life-threatening complications. The novelty lies in emphasizing the diagnostic challenges and the necessity for clinicians to consider diabetic ketoacidosis even when imaging suggests alternative causes. Case presentation This case report describes a 59-year-old Han female patient who was admitted to the hospital for "generalized abdominal pain without obvious cause for 3 days" and was diagnosed with left ureteral stones. Initial imaging revealed a left ureteral stone and hydronephrosis, prompting ureteral stent placement. Despite antispasmodics, analgesics, and stent insertion, her pain persisted. Diabetic ketoacidosis was subsequently confirmed through laboratory tests. Following comprehensive systemic treatment, metabolic parameters were successfully normalized, and the patient recovered and was discharged from the hospital. Conclusion The mechanisms and treatment approaches for abdominal pain caused by ketoacidosis and ureteral stones differ significantly. Clinicians treating abdominal pain in patients with a history of diabetes should consider the possibility of ketoacidosis-induced abdominal pain, especially when conventional antispasmodic and analgesic treatments for ureteral stones are ineffective. Prompt identification of diabetic ketoacidosis via comprehensive clinical assessment and laboratory investigations is crucial to avoid delays in appropriate treatment. Enhanced recognition of the overlapping symptoms between diabetic ketoacidosis and ureteral stones can minimize diagnostic errors and lead to better patient outcomes.https://doi.org/10.1186/s13256-025-05478-7Diabetic ketoacidosisUreteral stonesMisdiagnosisAbdominal painCase report
spellingShingle Minghe Zhang
Jian Li
Lianhui Fan
Hongtao Liu
Misdiagnosis of diabetic ketoacidosis: a case report
Journal of Medical Case Reports
Diabetic ketoacidosis
Ureteral stones
Misdiagnosis
Abdominal pain
Case report
title Misdiagnosis of diabetic ketoacidosis: a case report
title_full Misdiagnosis of diabetic ketoacidosis: a case report
title_fullStr Misdiagnosis of diabetic ketoacidosis: a case report
title_full_unstemmed Misdiagnosis of diabetic ketoacidosis: a case report
title_short Misdiagnosis of diabetic ketoacidosis: a case report
title_sort misdiagnosis of diabetic ketoacidosis a case report
topic Diabetic ketoacidosis
Ureteral stones
Misdiagnosis
Abdominal pain
Case report
url https://doi.org/10.1186/s13256-025-05478-7
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AT jianli misdiagnosisofdiabeticketoacidosisacasereport
AT lianhuifan misdiagnosisofdiabeticketoacidosisacasereport
AT hongtaoliu misdiagnosisofdiabeticketoacidosisacasereport