FRI658 Diabetic Ketoacidosis Masked By Cannabis In Type 2 Diabetes Mellitus

Disclosure: J. Bosques-Lorenzo: None. S. Velazquez-Acevedo: None. J. Baez-Torres: None. J. Colon-Castellano: None. Background: With the legalization of cannabis in many states, cannabis-related emergency visits have doubled. In recent years, hyperglycemic ketosis and altered glycemic control have been more frequently described in diabetic patients who are also cannabis users. Physicians mostly rely on pH and bicarbonate to diagnose and classify diabetic ketoacidosis (DKA). However, diabetic-cannabis users with typical DKA symptoms may present with alkalosis rather than acidosis. Clinical Case: We present the case of a 71-year-old male patient with a history of insulin-dependent type 2 diabetes mellitus, hypertension, and hyperlipidemia who came to the ED with a chief complaint of increased tiredness, fatigue, polyuria, polydipsia, and a home blood glucose measurement of greater than 500 mg/dl. Labs were remarkable for central blood glucose of 528 mg/dl, b-hydroxybutyrate of 42.1 mg/dl, and anion gap of 18.5mEq/L. Urine was also positive for glucose and ketones. However, arterial blood gasses showed a pH of 7.438 and bicarbonate of 25.5 mmol/l which did not meet the criteria for typical DKA. Upon record review, the patient had prior toxicology tests which were positive for cannabinoids. This admission wasn’t the exception. Studies have suggested that diabetic cannabis users tend to present with metabolic alkalosis despite high anion gap ketosis. Therefore, the patient was managed as per DKA protocol with adequate response and improvement of symptoms. Conclusion: The diagnosis of DKA in cannabis users may be frequently missed due to its differing and conflicting acid-base profile compared with non-cannabis users. Gastric delay and frequent vomiting have been suggested as the likely cause of alkalosis in these patients. Our patient did not present with severe vomiting; therefore, this case suggests that an alternate mechanism for alkalosis is possible and that relying only on pH and bicarbonate can be misleading. This case highlights the importance of screening urine toxicology for cannabis in patients who do not meet the typical criteria for DKA (pH >7.4 and bicarbonate >15 mmol/L) to provide the most effective treatment. Presentation: Friday, June 16, 2023