Dyabetic Ketoacidosis with an Acute Abdomen as a First Manifestation of Type 1 Diabetes Mellitus

Abstract

Context. Diabetic pseudoperitonitis is a very rare complication of the type 1 diabetes mellitus and it is associated with a severe ketoacidosis. The exact pathogenesis of the status is still unclear, the typical presentation is an acute abdomen by the patient. To confirm the diagnosis, it is necessary to make examinations, which exclude other possible reason of an acute abdomen by the patient (laboratory tests, abdominal ultrasound or a CT scan). Case presentation. A 46-years old man was admitted to the hospital wih a history of a 10 days epigastric pain. Laboratory tests, abdominal ultrasound, CT scan and upper endoscopy were performed, the reason of the pain remained unclear. Because of the peritoneal signs at the first day of the hospitalisation an acute surgery was indicated, without any pathology at the laparoscopy. A severe metabolic acidosis was recognized only after the surgery, the initial hypoglycaemia rose up after giving a total parenteral nutrition to the patient. The increase of the glycaemia, the severe metabolic acidosis with glycosuria and ketonuria, and the elevation of the glycated haemoglobin brought us to the diagnosis of the new onset of the diabetes. Conclusion. Diabetic pseudoperitonitis with the picture of an acute abdomen can occur as a first manifestation of the diabetes. Thinking of this rare complication and recognising it can avoid unnecessary acute surgery by the patient.

New Diabetic Medication Sodium-Glucose Cotransporter-2 Inhibitors Can Induce Euglycemic Ketoacidosis and Mimic Surgical Diseases: A Case Report and Review of Literature

“…The symptom of abdominal pain in the postoperative context might cause non-conclusive diagnostic imaging or inadequate surgery ( 31 , 32 ). In the presented case, relaparotomy was indicated due to the imitation of the acute abdomen also known as “pseudoperitonitis diabetica” ( 4 ). Iqbal et al published a case series of SGLT2-I-induced EDKA in three patients after bariatric surgery leading to computer tomography and/or angiography, whereas Lane et al reported a case with explorative laparoscopy due to unclear postoperative abdominalgia ( 31 , 34 ).…”

“…These clinical features are potentially triggered by DKA and can lead to the suspicion of surgical diseases. As a result, affected patients might be admitted to surgical departments where they undergo operations without any intraoperative correlate ( 4 , 5 ).…”

Review article: Abdominal pain and diabetes mellitus in the emergency department

“…DKA is associated with acute epigastric pain in 48% of adults and 62% of children, and may mimic an acute abdomen, so‐called diabetic pseudoperitonitis 5,6 . Epigastric pain may persist for days after correction of metabolic acidosis, suggesting peritoneal irritation by ketone bodies may be the cause of pain 7 . Severe abdominal pain with signs of acute peritonitis leading to laparotomy has also been described with sodium‐glucose transporter protein 2 inhibitor‐euglycemic ketoacidosis 8 .…”

“…5,6 Epigastric pain may persist for days after correction of metabolic acidosis, suggesting peritoneal irritation by ketone bodies may be the cause of pain. 7 Severe abdominal pain with signs of acute peritonitis leading to laparotomy has also been described with sodium-…”

Diabetische Ketoazidose

“…ein sogenannter "Pseudoperitonismus", das heißt eine Reizung des Peritonismus im Rahmen der Ketoazidose. Dies kann unter Umständen auch als Appendizitis fehldiagnostiziert werden, sodass der Begriff "Pseudoappendizitis" entstanden ist [7]. Aufgrund der Hyperosmolarität kann es zu einer osmotischen Diurese kommen, die sich klinisch als Polyurie und Polydipsie präsentiert.…”