Spontaneous pneumomediastinum in diabetic ketoacidosis: A case series of 10 patients

Xu, Wei; Sun, Lichao; Zang, Xiu-xian; Wang, Hong; Li, Wei

doi:10.5847/wjem.j.1920-8642.2022.029

Cited by 3 publications

(1 citation statement)

References 18 publications

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“…Coexistence of DKA and pneumomediastinum was first described in 1937 and has been reported in 90 cases since 12–14. We reviewed 40 case reports and series with 51 patients having DKA and pneumomediastinum (online supplemental material 1).…”

Section: Discussionmentioning

confidence: 99%

Pneumomediastinum complicating diabetic ketoacidosis

et al. 2023

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Pneumomediastinum is an uncommon finding in patients with diabetic ketoacidosis (DKA) and may occur spontaneously or secondary to an effort rupture of the oesophagus. Excluding oesophageal rupture is important, as delaying treatment increases the risk of mortality. We discuss a case of DKA complicated by vomiting, pneumomediastinum, pneumopericardium and air in the epidural space. Instead of fluoroscopic oesophagography, chest CT was used to investigate oesophageal rupture. We present an overview of case reports and retrospective studies illustrating the utility of chest CT in the investigation of oesophageal rupture over fluoroscopic oesophagography.

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Section: Discussionmentioning

confidence: 99%

Pneumomediastinum complicating diabetic ketoacidosis

et al. 2023

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Metabolic acidosis and sudden infant death syndrome: overlooked data provides insight into SIDS pathogenesis

Goldwater,

Gebien

2024

World J Pediatr

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Background Decades of mainstream SIDS research based on the Triple Risk Model and neuropathological findings have failed to provide convincing evidence for a primary CNS-based mechanism behind putative secondary dyshomeostasis (respiratory or cardiac) or impaired arousal. Newly revealed data indicate that severe metabolic acidosis (and severe hyperkalemia) is a common accompaniment in SIDS. This supports the direct effect of sepsis on vital-organ function and occurrence of secondary CNS changes accompanied by the dyshomeostasis leading to SIDS. Data sources Using PubMed and Google Scholar literature searches, this paper examines how metabolic acidosis and sepsis might contribute to the underlying pathophysiologic mechanisms in SIDS. Results The discovery of a series of non-peer-reviewed publications provided the basis for a serious examination of the role of metabolic acidosis and sepsis in SIDS. Most SIDS risk factors relate directly or indirectly to infection. This consequently elevated the position of septic or superantigenic shock and viremia in causing secondary organ failure leading to SIDS. The latter could include diaphragmatic failure, as evidenced by peripheral respiratory (muscle) arrests in experimental septic shock, as well as infectious myositis and diaphragm myopathy in sudden unexpected deaths, including SIDS. In addition, just as acidosis lowers the threshold for ventricular fibrillation and sudden cardiac arrest, it could also contribute to similarly unstable diaphragm excitation states leading to respiratory failure. Conclusions This paper uniquely reveals compelling evidence for a connection between metabolic acidosis, sepsis, viral infections, and sudden unexpected child deaths and provides a solid basis for further work to define which pathway (or pathways) lead to the tragedy of SIDS. It is recommended that all autopsies in sudden unexpected deaths should include pH, bicarbonate, lactate, and electrolyte measurements, as well as diaphragm histology.

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