Multiple complications in severe diabetic ketoacidosis. A short review of the literature

Abstract

Diabetic ketoacidosis may be associated with a wide variety of complications, some of which are uncommon and not widely appreciated. A case of severe ketoacidosis with multiple complications including septicaemia, pneumomediastinum, gastro-intestinal haemorrhage, magnesium depletion and multiple mononeuropathy is reported in a 17-year old girl who made a successful recovery. The patient had not taken insulin for almost 4 days, had no preceding illness and was admitted in a near moribund state with hypothermia (34.2 degrees C), hypotension (80/50) and an arterial pH less than 6.8. There was a leukocytosis 41,200, the blood culture grew haemolytic streptococci and chest radiology showed pneumomediastinum. I.v. therapy was continued for some days and the patient developed clinical features of magnesium depletion. During the recovery period she developed multiple mononeuropathy. A brief review of these complications is given.

Bilateral optic atrophy following diabetic ketoacidosis

“…Isolated or multiple mononeuropathies are rare but have been noted and referred to as ketoacidotic neuropathy' [3]. These mononeuropathies are probably a result of disturbance in nerve metabolism combined with mechanical pressure at exposed sites such as the knee (common peroneal nerve) and the elbow (ulnar nerve) [4]. Features of diabetic autonomic neuropathy may occur following DKA such as bladder atony, gastric atony [5] and temporary impotence [6].…”

A 32-Year-Old Male with Recurrent Hypothermia and Hypotension of Unknown Cause

“…This exclusion was further supported by the fact that there was no infection associated with his previous episodes. The patient's normal glucose level excluded hypoglycemia [ 4 ] or hyperglycemia [ 5 ] as the underlying cause of his hypothermia. His normal thyroid function tests excluded hypothyroidism-induced hypothermia.…”