A study of thirty-six unselected episodes of diabetic ketoacidosis showed that multiple serum enzyme abnormalities, severe in degree, occurred in eleven (30.6 per cent). Seven could be explained wholly or partly by concurrent illness, such as myocardial infarction or gallstones, but no cause could be found in the other four cases. Since multiple enzyme abnormalities of lesser degree occurred without clinical explanation in a further three cases, the over-all incidence of multiple unexplained enzyme elevation was 19.4 per cent. A single serum enzyme activity was elevated over several consecutive samples during nine episodes: CPK was the enzyme concerned in three, and six were associated with abnormalities in enzymes specific for hepatobiliary disorders.

The prognosis is seriously affected by concurrent illness, but is not altered by the existence of enzyme abnormalities per se, no matter how severe; these may reflect transient leakage of enzymes from hepatocytes reversibly damaged by lysosomal constituents.

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