2.4  Laboratory tests
The results of biochemistry examinations are shown in Table 1. Arterial blood gas revealed a pH of 7.31 and partial pressure of carbon dioxide of 22 and bicarbonate of 3. Serum sodium 144 mmol/L, potassium 6.9 mmol/l, bicarbonate 7 mmol/l, blood urea nitrogen 50 mg/dl, and creatinine 3.5 mg/dl. Serum glucose was 27.8 mmol/L. Hemoglobin A1c (HbA1c) was 13.6%. Serum triglyceride was 7.8 mmol/L, free fat acid concentration were 1.05 mmol/L. Serum acetone was detectable in moderate quantity. C-peptide was non-detectable. Urinalysis demonstrated a glucose concentration of more than 1000 mg per deciliter (56 mmol per liter) with strong positive ketones(++++) and negative protein. His serum amylase was in normal range. The white-cell count was 15,000 per cubic millimeter, and the hematocrit was 40%. Islet-associated autoantibody (IAA), Insulinoma associated antigen 2 (IA-2), Islet cell antibodies (ICA) and glutamate decarboxylase (GAD-65) antibody were negative. There was hepatic adipose infiltration by abdominal ultrasound.
Table 1  Laboratory findings of the patient with KPD at the time of admission. He underwent euglycemic clamp test for valuation of insulin sensitivity and pancreatic beta cell function when his condition quickly stabilized in three days. The glucose disposal ratio (GDR) during the steady-state of euglycemic clamp test was 5.62 mg/kg/min and glycemic metabolism (M) value was 2.87 mg/kg/min during hyperglycemic clamp test, which means there were low insulin sensitivity and extremely deficient in insulin secretion.