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We report the first case of diabetic ketoacidosis (DKA) in a worker recently exposed to high levels of the fungicide chlorothalonil.
In April 2011, a 56-year-old male farmer was admitted with severe dehydration, hypotension, vomiting and general malaise. Blood tests showed glucose 861 mg/dL (70–110), HbA1c 14.3% (4–6), pH 7.05 (7.37–7.43) and bicarbonate 3.8 mEq/L (20–24). A urinalysis showed intense ketonuria. A diagnosis of DKA was made.
However, the presentation of DKA was unusual; the patient was a healthy man, he had no evidence of prior hyperglycaemia or risk factors for diabetes and type 1 autoantibodies were negative. Since the symptoms suggested an occult noxa we questioned him more thoroughly. Two months before admission, he had been hired to clean a farm …
Contributors JCF-G, SG-R and FS cared for the patient. JCF-G and FJT wrote the manuscript. NO and JPA performed the laboratory tests and revised the final manuscript.
Competing interests JCF-G is a recipient of a ‘Rio Hortega’ contract from the ‘Instituto de Salud Carlos III’, Madrid, Spain (CM12/00059). JPA is a recipient of a postdoctoral contract of the CISPS, Junta de Andalucía (RH-0092-2013).
Patient consent Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.