Isolated Renal Tubular Acidosis Type II with Resistant Diabetic Ketoacidosis

Background: Kidneys play a pivotal role in maintaining the acid-base balance along with the respiratory system. Renal tubular acidosis (RTA) type 2 is one of the causes of systemic acidosis caused by impairment of the ability of renal tubules to maintain acid base balance. Aim: This case report highlights the importance of considering renal tubular acidosis for any diabetic ketoacidosis (DKA)patient who demonstrates resistant acidosis despite adequate management. Case Report: Our patient was diagnosed as DKA initially in the emergency department then after admission to ICU we found no response of treatment despite of giving intravenous fluids and treating the cause. Biochemical analysis demonstrated isolated RTA type 2 with high level of bicarbonate combined with normal levels of amino acid, phosphate, uric acid, and glucose in urine. We confirmed RTA type 2 and infusion of bicarbonate was initiated. The condition improved significantly. Conclusion: RTA type2 should be considered in any case of refractory acidosis of DKA patient.