A Case of Multifactorial Diabetic Ketoacidosis Acquired in the Intensive Care Unit: A Case Report.

• Type of Material: Article
• Authors: Ceressa T. Ward, Emory University; Babar Fiza, Emory University; Amit Prabhakar, Emory University; Gaurav Budhrani, Emory University; Vanessa Moll Moll, Emory University
• Language: English
• Date: 2019-07-12
• Publisher: Cureus, Inc.
• Publication Version: Final Published Version
• Copyright Statement: © 2019, Ward et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.7759/cureus.5128
• Title of Journal or Parent Work: Cureus
• ISSN: 2168-8184
• Volume: 11
• Issue: 7
• Start Page: e5128
• End Page: e5128
• Keywords: intensive care unit (icu); diabetic ketoacidosis; hyperglycemia
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery

Abstract

Diabetic ketoacidosis (DKA) is a potentially fatal endocrine emergency resulting from uncontrolled diabetes mellitus (DM). The development of DKA has been linked to a number of precipitating factors such as infectious process, ischemia, medications, and other medical-surgical illnesses. These factors have been found to aggravate or unmask pre-existing glucose dysregulation secondary to absolute or relative insulin deficiency and increased levels of counter-regulatory hormones. We describe the case of a 61-year-old male with a history of insulin dependent DM who develops DKA postoperatively after a three-vessel coronary artery bypass surgery and mitral valve repair while in the intensive care unit (ICU). The patient's postoperative course was complicated by presumed pneumonia and hyperactive delirium. On postoperative day (POD) five, the patient's insulin infusion was held due to non-symptomatic hypoglycemia. Eleven hours later, the insulin infusion was resumed to treat DKA after laboratory findings revealed hyperglycemia, an elevated β-hydroxybutyrate, and anion gap metabolic acidosis. Multiple contributing factors for the development of DKA are suspected and discussed. It is paramount that clinicians are knowledgeable of the multiple factors that can contribute to the development of DKA in the ICU.