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Diabetic ketoacidosis following chlorothalonil poisoning
  1. José C Fernández-García1,2,
  2. Juan P Arrebola3,4,
  3. Stella González-Romero5,6,
  4. Federico Soriguer5,6,
  5. Nicolás Olea3,4,
  6. Francisco J Tinahones1,2
  1. 1Endocrinology Department, Virgen de la Victoria University Hospital, Málaga, Spain
  2. 2Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
  3. 3Instituto de Investigación Biosanitaria de Granada, San Cecilio University Hospital, University of Granada, Granada, Spain
  4. 4Spanish Biomedical Research Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
  5. 5Endocrinology Department, Carlos Haya University Hospital, Málaga, Spain
  6. 6Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
  1. Correspondence to Dr José C Fernández-García, Endocrinology Department, Virgen de la Victoria University Hospital, Málaga 29010, Spain; josecarlosfdezgarcia{at}

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Dear Editor,

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 …

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  • 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.