Abstract
This case report presents a 49 year-old female with type 1 diabetes admitted to the intensive care unit with acute
respiratory failure and severe diabetic ketoacidosis with an initial measurement of blood glucose level of 1,200 mg L–1,
pH 6.78, serum HCO3
– 3.2 mmoL L–1 and BE –31.2 mmoL L–1. Analysis of the blood gasometric parameters with the
Stewart approach and the traditional Henderson-Hasselbalch concept enabled the discovery of metabolic acidosis
caused by unidentified anions (mainly ketons