How Low Can You Go? Severe Acidemia in a Patient with Type 2 Diabetes and Diabetic Ketoacidosis

Year 2018, Volume: 9 Issue: 2, 30 - 32, 01.04.2018

Kristen Liska Sar Medoff Vanessa Moll Patrick Meloy

Abstract

Introduction: Type 2 diabetes mellitus (T2DM) is a common disease encountered in the emergency department. Diabetic ketoacidosis (DKA) is a potentially life-threatening metabolic disturbance characterized by hyperglycemia, metabolic acidosis, and ketonemia. Traditionally associated with type 1 diabetes mellitus, DKA is becoming increasingly common in type 2 diabetics.Case Report: We present an extreme case of a 66-year-old female with known type 2 diabetes mellitus who presented with altered mental status and severe metabolic ketoacidosis with a pH of 6.55 and blood glucose of 963 mg/dL. The patient rapidly decompensated in the emergency department, requiring emergent intubation and central venous access. Fluid resuscitation was applied, and the patient was started on an insulin infusion. Her blood pressure was supported with dual vasopressor therapy, and she was transferred to the medical intensive care unit. She recovered rapidly and was discharged from the hospital 5 days later with no neurologic deficits.Conclusion: This case is notable for the patient’s extreme acidemia, one of the lowest recorded in the literature for a type 2 diabetic who survived and was discharged from the hospital. It highlights the importance of early, aggressive treatment of DKA in the emergency department coupled with continued critical care management in the intensive care unit

Keywords

Critical care, resuscitation, diabetic ketoacidosis, diabetes mellitus, DKA, metabolic acidosis

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