Delirium in Diabetic Ketoacidosis: A Case Report

Abstract

A 15-year-old female patient with known type 1 diabetes mellitus was referred because of abdominal pain. On admission, she was alert but dehydrated with marked Kussmaul breathing. Blood glucose was 414 mg/dL (23 mmol/L). Blood gas analysis revealed severe metabolic acidosis (pH: 6.99) with an elevated anion gap (29.8 mmol/L) and an increased base excess (-25.2 mmol/L). At the sixth hour of treatment with intravenous fluids and insulin, the patient became delirious. The delirium persisted despite the normalization of the acidosis and became difficult to manage. Brain imaging studies revealed neither brain edema nor other intracranial pathology. No evidence of intoxication could be found. The patient gradually regained consciousness and was diagnosed as a case of severe diabetic ketoacidosis (DKA) associated with infection. We were unable to find a similar case in the pediatric literature and thought that reporting this unusual case would be a contribution to the literature on DKA in children.Conflict of interest:None declared.

The relationship between diabetic ketoacidosis and suicidal or self-injurious behaviour: A systematic review

“…One case has associated DKA with a metabolic encephalopathy, although in the case there were a number of potential contributory factors including a preexisting neurological disorder and substance use [12] . There is one case in the literature of a DKA-induced episode of delirium, in an adolescent [13] . In diabetes more broadly hyperglycemia-related brain injury is more commonly seen in chronic hyperglycaemia and the associated microvascular complications.…”

A rare presentation of acute hyperglycemia with secondary mania: a case report

“…2,3 Patients with diabetes mellitus experiencing ketoacidosis or hypoglycaemia have also been shown to experience delirium. [4][5][6] The literature related to the occurrence and management of mania associated with hyperglycaemia is limited. Through this case report, author present an interesting case of acute hyperglycaemia associated with secondary mania.…”