症例は31歳の男性。清涼飲料水多飲のエピソードはなかったが，血糖高値およびケトアシドーシスを指摘されて紹介となった。入院時より補液とインスリン治療を開始し，1日最高42単位まで使用したがその後減量でき，1日11単位と内服で退院となった。1型糖尿病に比べて2型糖尿病でのケトアシドーシス症例は少ないとされていたが，清涼飲料水ケトーシスを含むketosis-prone type 2 diabetes（KPDM）などの報告も散見され，またSGLT2使用症例の増加に伴い増えてくると考えられる。今後2型糖尿病でもケトアシドーシスを念頭に入れての診療が必要である。

   A 31-year-old male, with no history of excessive soft drink consumption was referred to our hospital because of hyperglycemia and ketoacidosis. Immediately after admission, the patient started receiving fluid replacement and insulin therapy. The insulin dosage was titrated to a maximum of 42 units, subsequently tapered, and reduced to 11 units daily in combination with oral medication at discharge. Although it has been recognized that ketoacidosis is less common in type 2 than in type 1 diabetes, ketosis-prone type 2 diabetes (KPDM), including soft drink-induced ketosis, has been sporadically reported, and such cases are likely to become more frequent with the increasing use of SGLT2 inhibitors. The risk of ketoacidosis should be considered even when treating patients with type 2 diabetes.