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The low bone turnover observed in a significant proportion of patients in early stages of CKD could be due to the initial predominance of bone turnover inhibitory conditions such as resistance to the action of PTH, reduced serum calcitriol levels, sex hormone deficiency, diabetes, inflammation and malnutrition, and uremic toxins leading to the repression of osteocyte Wnt--catenin signaling and increased expression of Wnt antagonists such as sclerostin, Dickkopf-1 and secreted frizzled-related protein 4 (7,8)

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On the sixth day of persistent vomiting, due to significant dehydration and weakness, the patient was admitted to the emergency department of a hospital, where severe diabetic ketoacidosis was diagnosed

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