A Case Of Diabetic Ketoacidosis Complicated By Fatal Acute Abdominal Aortic Thrombosis
Diabetic ketoacidosis is one of the most serious acute complications of diabetes mellitus. Arterial thrombosis complicating diabetic ketoacidosis (DKA) is a relatively common concomitant life-threatening illness. However, acute abdominal aortic thrombosis in DKA is very rare. We report a case of a 65-year-old woman who presented with abdominal aortic thrombus complicating DKA. She was brought to our hospital because of loss of consciousness. Her initial laboratory examination showed that glucose was 407 mg/dl, ketone bodies were positive, and pH was 6.91. Thus, we diagnosed her as having diabetic ketoacidosis. However, physical examination revealed pulseless femoral arteries, and laboratory testing revealed elevated lactate, D-dimer, and serum potassium levels. She complained of abdominal pain and had a bloody stool after admission. Initial non-contrast computed tomography (CT) did not show the occlusion of the arteries. Eighteen hours after admission, we found severe cyanosis of her bilateral lower limbs, and the contrast-enhanced CT revealed the thrombus in abdominal aorta extending into the bilateral common iliac arteries. This case indicates that DKA can be complicated by thrombosis. We should maintain a high index of suspicion for thrombosis in patients with DKA. Continue reading >>
Introduction Diabetic ketoacidosis (DKA) is a dangerous complication of diabetes caused by a lack of insulin in the body. Diabetic ketoacidosis occurs when the body is unable to use blood sugar (glucose) because there isn't enough insulin. Instead, it breaks down fat as an alternative source of fuel. This causes a build-up of a by-product called ketones. Most cases of diabetic ketoacidosis occur in people with type 1 diabetes, although it can also be a complication of type 2 diabetes. Symptoms of diabetic ketoacidosis include: passing large amounts of urine feeling very thirsty vomiting abdominal pain Seek immediate medical assistance if you have any of these symptoms and your blood sugar levels are high. Read more about the symptoms of diabetic ketoacidosis. Who is affected by diabetic ketoacidosis? Diabetic ketoacidosis is a relatively common complication in people with diabetes, particularly children and younger adults who have type 1 diabetes. Younger children under four years of age are thought to be most at risk. In about 1 in 4 cases, diabetic ketoacidosis develops in people who were previously unaware they had type 1 diabetes. Diabetic ketoacidosis accounts for around half of all diabetes-related hospital admissions in people with type 1 diabetes. Diabetic ketoacidosis triggers These include: infections and other illnesses not keeping up with recommended insulin injections Read more about potential causes of diabetic ketoacidosis. Diagnosing diabetic ketoacidosis This is a relatively straightforward process. Blood tests can be used to check your glucose levels and any chemical imbalances, such as low levels of potassium. Urine tests can be used to estimate the number of ketones in your body. Blood and urine tests can also be used to check for an underlying infec Continue reading >>
Diabetic Ketoacidosis With Fatal Cerebral Edema
Abstract One case of diabetic ketoacidosis with irreversible cerebral edema in a 10-year-old boy is presented. Death ensued in spite of apparently adequate fluid, electrolyte, and insulin therapy, and it followed a brief period of clinical and chemical improvement suddenly and unexpectedly. Although the pediatric literature makes no note of this syndrome, a review of the general medical literature does reveal some scattered case reports which deal with a similar pattern. The pathogenesis is discussed with several mechanisms presented as possible factors. Suggestions are made regarding modification of therapy, but these are admittedly tentative and require further studies. Abstract The topical use of isopropyl alcohol to reduce fever in children is a common procedure in pediatric practice. Deep coma has been reported in two children, presumably from inhalation of the alcohol during sponging procedures in poorly ventilated areas.1,2 Absorption through the skin has not been reported to be a significant portal of entry.3 The toxic effects of ingested isopropanol in humans are reported to be similar to those of ethanol, but they occur at lower blood concentrations.4 The lethal dose for adults of ingested 70% isopropyl alcohol has been estimated to be 240 ml.5 The following case is reported as an example of coma in an infant following injudicious topical application of isopropanol for the relief of fever. Continue reading >>
A Clinical Case Of Clozapine-induced Fatal Diabetic Ketoacidosis
Clozapine, a second generation medication, has become the atypical antipsychotic drug of choice for refractory or treatment-resistant schizophrenia. In addition to the high risk of agranulocytosis and seizures, clozapine treatment is increasingly associated with significant metabolic effects, such as hyperglycemia, central weight gain and adiposity, hypertriglyceridemia, and elevated low-density lipoprotein cholesterol. A potentially life-threatening complication of altered metabolism is diabetic ketoacidosis (DKA). This report details a case of fatal DKA in a schizophrenic patient undergoing treatment with clozapine. An African–American male in his 20s with a medical history significant for schizophrenia was presented to the psychiatric inpatient ward with severe paranoid thoughts and aggressive behavior. After trials of risperidone, olanzapine, and haloperidol—all of which failed to adequately control his psychotic symptoms—clozapine titration was initiated and he showed significant improvement. Weight gain was observed throughout hospitalization, but all blood and urine test results showed no metabolic or hematological abnormalities. The patient was discharged for outpatient treatment on clozapine (125 mg morning and 325 mg evening) along with divalproex sodium and metoprolol. Six days post-discharge, the patient died. A medical autopsy later ruled that the death was due to DKA without any evidence of contributory injuries or natural disease. Significant increase in body mass index from 28.7 to 33.5 was observed during hospitalization. The blood glucose level, measured after his death, was found to be 500 mg/dL. Altered metabolism due to clozapine can lead to dyslipidemia-mediated-pancreatic-beta-cell damage, decreased insulin secretion as well as insulin resis Continue reading >>
Acute Complications Of Diabetes - Diabetic Ketoacidosis
- [Voiceover] Oftentimes we think of diabetes mellitus as a chronic disease that causes serious complications over a long period of time if it's not treated properly. However, the acute complications of diabetes mellitus are often the most serious, and can be potentially even life threatening. Let's discuss one of the acute complications of diabetes, known as diabetic ketoacidosis, or DKA for short, which can occur in individuals with type 1 diabetes. Now recall that type 1 diabetes is an autoimmune disorder. And as such, there's an autoimmune destruction of the beta cells in the pancreas, which prevents the pancreas from producing and secreting insulin. Therefore, there is an absolute insulin deficiency in type 1 diabetes. But what exactly does this mean for the body? To get a better understanding, let's think about insulin requirements as a balancing act with energy needs. Now the goal here is to keep the balance in balance. As the energy requirements of the body go up, insulin is needed to take the glucose out of the blood and store it throughout the body. Normally in individuals without type 1 diabetes, the pancreas is able to produce enough insulin to keep up with any amount of energy requirement. But how does this change is someone has type 1 diabetes? Well since their pancreas cannot produces as much insulin, they have an absolute insulin deficiency. Now for day-to-day activities, this may not actually cause any problems, because the small amount of insulin that is produced is able to compensate and keep the balance in balance. However, over time, as type 1 diabetes worsens, and less insulin is able to be produced, then the balance becomes slightly unequal. And this results in the sub-acute or mild symptoms of type 1 diabetes such as fatigue, because the body isn Continue reading >>
Why Is Diabetic Ketoacidosis So Dangerous?
The main thing, which Carol Linn Miller so very correctly points out, is that diabetic ketoacidosis can be fatal. But having been through it, what makes the condition so dangerous is you don't necessarily feel like you need to get it treated. You go off into a kind of la-la land, and don't take necessary action. If you wait too long, you may die. I didn't go to an ER until I suddenly went blind, and it turned out I was near death. I knew something was wrong, but the part of my brain that tells you "Danger! Danger!" wasn't working. Continue reading >>
As A Doctor, What Is The Biggest Mistake That You've Made?
My biggest mistake was giving too much naloxone to a patient with opioid tolerance because she as bradypneic. For non medical people browsing: Naloxone is an opioid reversal drug (an antidote). When people overdose on opioids, such as morphine, you can inject that drug to quickly “wake them up”. People overdosing on morphine breath slowly. They can even stop breathing (which isn’t optimal, obviously). My patient was breathing slowly (6 per minute) and her blood oxygen level was low (low 80%). She had been on morphine for a long time for chronic pain, so she was taking impressive doses of morphine. She wouldn’t wake up, so I thought I’d give her a little naloxone to help with her breathing. I went for the lowest dose recommended in the monograph (1/10 of a full dose), because I knew I just needed to control her breathing. It turns out that in order to do that, the dose is 1/10 of what I gave her (1/100 of the full dose). She woke up a few seconds after the injection. Then she started screaming. She was in agony. I had completely reversed her morphine. The unfortunate thing with naloxone is that the only way to “fix it” is to wait. 30 minutes of a woman screaming on the ward. We tried hard to help her through it, but it was terrifying. I wrote about that experience on my blog. That story is one of the main reason why I wrote my app, MD on Call after my first year of residency. We rarely talk about our mistakes, but we should. People learn from others mistakes. On top of that, everyone makes mistakes. Everyone. Continue reading >>
Diabetic Ketoacidosis (dka)
Diabetic ketoacidosis, also called DKA, is a life-threatening complication occurring with undiagnosed and/or untreated Type 1 diabetes in adults and children. DKA symptoms often remain undiagnosed because they can look like (mimic) influenza, a stomach bug, strep infections, and other common illnesses and conditions. However, someone may actually have a common illness and DKA at the same time, causing the common illness symptoms to hide (mask) the underlying DKA symptoms. Either way, untreated Type 1 diabetes and DKA are 100% fatal. IMPORTANT: Diabetic ketoacidosis is LIFE-THREATENING and can progress quickly–often within 24 hours! If you or a loved one have any of the following symptoms with VOMITING AND LETHARGY COMBINED WITH LABORED BREATHING, do not consume sugar and seek emergency medical care immediately. Insist medical personnel Test One Drop of blood or urine for glucose (sugar) levels. DKA can be fatal! SYMPTOMS OF DKA: excessive thirst frequent urination or bedwetting increased appetite or sugar cravings abdominal pain irritability, grouchiness, or mood changes headaches and/or vision changes itchy skin/genitals (yeast or thrush) sudden weight loss flushed, hot, dry skin nausea and vomiting* fruity/acetone scented breath* lethargy, drowsiness, or fatigue* labored, rapid, and/or deep breathing* confusion, stupor, or unconsciousness* *A combination of any of these symptoms can be life-threatening. Seek EMERGENCY CARE. When new onset Type 1 diabetes remains undiagnosed and untreated the shortage of insulin causes blood glucose (sugar) levels to climb above the normal range. Without adequate insulin to regulate levels of glucose in the blood, high levels of acids called ketones build up in the body causing diabetic ketoacidosis. Ketones are toxic and if l Continue reading >>
Symptoms Of Diabetic Ketoacidosis: What You Need To Know
Diabetes can be hard to manage, but not properly controlling the disease can have dangerous and potentially deadly consequences. Ketoacidosis is one of them. This condition happens in people who don’t have enough insulin in their body, perhaps because they have not taken some of their insulin shots. The U.S. National Library of Medicine explains that when insulin is lacking, and the body cannot use ingested sugar as a fuel source, it starts to break down fat, which releases acids called ketones into the bloodstream. In large numbers, those ketones are poisonous and can cause deep, rapid breathing, dry skin and mouth, frequent thirst, a flushed face, headache, nausea, stomach pain, muscle stiffness, muscle aches, frequent urination, difficulty concentrating and fruity-smelling breath. If left untreated, the condition can be fatal, in part because it can eventually cause fluid to build up in the brain and for the heart and kidneys to stop working. There are ways to tell whether you have the condition or are approaching it, the Mayo Clinic says. A routine blood sugar test like the kind diabetics take all the time will show high blood sugar, and there are tests to measure the ketone levels in urine. The American Diabetes Association says that experts usually recommend using a urine test strip to check for ketones when blood glucose levels reach higher than 240 milligrams per deciliter. And when sick with a cold or flu, a person should “check for ketones every four to six hours” to be safe. That’s because infections or other illnesses can increase hormones like adrenaline and cortisol in the body, which then counter the work of insulin — “pneumonia and urinary tract infections are common culprits,” the Mayo Clinic warns. In addition to missed insulin shots and Continue reading >>
Diabetic Ketoacidosis In Dogs
My dog is diabetic. He has been doing pretty well overall, but recently he became really ill. He stopped eating well, started drinking lots of water, and got really weak. His veterinarian said that he had a condition called “ketoacidosis,” and he had to spend several days in the hospital. I’m not sure I understand this disorder. Diabetic ketoacidosis is a medical emergency that occurs when there is not enough insulin in the body to control blood sugar (glucose) levels. The body can’t use glucose properly without insulin, so blood glucose levels get very high, and the body creates ketone bodies as an emergency fuel source. When these are broken down, it creates byproducts that cause the body’s acid/base balance to shift, and the body becomes more acidic (acidosis), and it can’t maintain appropriate fluid balance. The electrolyte (mineral) balance becomes disrupted which can lead to abnormal heart rhythms and abnormal muscle function. If left untreated, diabetic ketoacidosis is fatal. How could this disorder have happened? If a diabetic dog undergoes a stress event of some kind, the body secretes stress hormones that interfere with appropriate insulin activity. Examples of stress events that can lead to diabetic ketoacidosis include infection, inflammation, and heart disease. What are the signs of diabetic ketoacidosis? The signs of diabetic ketoacidosis include: Excessive thirst/drinking Increased urination Lethargy Weakness Vomiting Increased respiratory rate Decreased appetite Weight loss (unplanned) with muscle wasting Dehydration Unkempt haircoat These same clinical signs can occur with other medical conditions, so it is important for your veterinarian to perform appropriate diagnostic tests to determine if diabetic ketoacidosis in truly the issue at hand Continue reading >>
Brief Report Risperidone-associated Newly Diagnosed Diabetes And Fatal Diabetes Ketoacidosis In A Young Schizophrenic Patient
A 27-year-old man, who has been using risperidone for two months as the treatment for schizophrenia, with no previous history of diabetes was admitted to the hospital with the presentation of severe diabetes ketoacidosis and subsequent fatal progression. Continue reading >>
What is alcoholic ketoacidosis? Cells need glucose (sugar) and insulin to function properly. Glucose comes from the food you eat, and insulin is produced by the pancreas. When you drink alcohol, your pancreas may stop producing insulin for a short time. Without insulin, your cells won’t be able to use the glucose you consume for energy. To get the energy you need, your body will start to burn fat. When your body burns fat for energy, byproducts known as ketone bodies are produced. If your body is not producing insulin, ketone bodies will begin to build up in your bloodstream. This buildup of ketones can produce a life-threatening condition known as ketoacidosis. Ketoacidosis, or metabolic acidosis, occurs when you ingest something that is metabolized or turned into an acid. This condition has a number of causes, including: shock kidney disease abnormal metabolism In addition to general ketoacidosis, there are several specific types. These types include: alcoholic ketoacidosis, which is caused by excessive consumption of alcohol diabetic ketoacidosis (DKA), which mostly develops in people with type 1 diabetes starvation ketoacidosis, which occurs most often in women who are pregnant, in their third trimester, and experiencing excessive vomiting Each of these situations increases the amount of acid in the system. They can also reduce the amount of insulin your body produces, leading to the breakdown of fat cells and the production of ketones. Alcoholic ketoacidosis can develop when you drink excessive amounts of alcohol for a long period of time. Excessive alcohol consumption often causes malnourishment (not enough nutrients for the body to function well). People who drink large quantities of alcohol may not eat regularly. They may also vomit as a result of drinking too Continue reading >>
Fatal Diabetic Ketoacidosis And Antipsychotic Medication.
Abstract Hyperglycemia and new onset diabetes have been described with certain antipsychotic medications and some of the initial presentations are fatal diabetic ketoacidosis (DKA). We report 17 deaths due to DKA in psychiatric patients treated with second generation antipsychotic medications. Death certificates and toxicology data were searched for DKA and hyperglycemia. We reviewed the medical examiner records which included the autopsy, toxicology, police, and medical examiner investigators' reports. The decedents ranged in age from 32 to 57 years (average 48 years). There were 15 men and two women. The immediate cause of death was DKA in all. The psychiatric disorders included: 10 schizophrenia, three bipolar/schizophrenia, two bipolar, and two major depression. The most frequent atypical antipsychotic medications found were quetiapine and olanzapine followed by risperidone. In 16 deaths, we considered the medication as primary or contributory to the cause of death. KEYWORDS: antipsychotic medication; atypical antipsychotics; diabetes; fatality; forensic pathology; forensic sciences; ketoacidosis Continue reading >>
Fatal Diabetic Ketoacidosis-a Potential Complication Of Mdma (ecstasy) Use.
Abstract A 19-year-old woman with insulin-dependent diabetes mellitus was found dead in bed having allegedly recently taken ecstasy and consumed alcohol. At autopsy, there were microhemorrhages in the brain with subnuclear vacuolization and Armanni-Ebstein changes in renal tubules. Biochemical analyses confirmed diabetic ketoacidosis (vitreous glucose-46.5 mmol/L; β-OH butyrate-13.86 mmol/L.). Toxicological analyses of blood showed a low level of 3,4-methylenedioxy-methamphetamine (MDMA) (0.01 mg/L), with acetone but no alcohol or other common drugs. Death was attributed to diabetic ketoacidosis most likely provoked by mixed MDMA/alcohol ingestion. Although the use of illicit drugs by young individuals with diabetes mellitus is being increasingly recognized, it has been noted that there is minimal information about the relationship between drug use and acute diabetic complications. Toxicological screening of cases of lethal diabetic ketoacidosis in the young may clarify lethal mechanisms in individual cases and also help to determine the extent of this problem. KEYWORDS: MDMA; death; diabetes mellitus; ecstasy; forensic science; hyperglycemia; ketoacidosis Continue reading >>
Print Overview Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated. If you have diabetes or you're at risk of diabetes, learn the warning signs of diabetic ketoacidosis — and know when to seek emergency care. Symptoms Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice: Excessive thirst Frequent urination Nausea and vomiting Abdominal pain Weakness or fatigue Shortness of breath Fruity-scented breath Confusion More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine testing kits — include: High blood sugar level (hyperglycemia) High ketone levels in your urine When to see a doctor If you feel ill or stressed or you've had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit. Contact your doctor immediately if: You're vomiting and unable to tolerate food or liquid Your blood sugar level is higher than your target range and doesn't respond to home treatment Your urine ketone level is moderate or high Seek emergency care if: Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 mill Continue reading >>