scholarly journals Simultaneous presentation of thyroid storm and diabetic ketoacidosis in a previously healthy 21-year-old man

2019 ◽  
Vol 12 (1) ◽  
pp. bcr-2018-227554
Author(s):  
David Wallington ◽  
Mark Schauer ◽  
Laura D Bauler
Keyword(s):  
Emergency Department ◽  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Simultaneous Presentation ◽  
Ventricular Rate ◽  
Thyroid Storm ◽  
Graves Disease ◽  
Laboratory Results ◽  
History Of

A 21-year-old young man with no history of diabetes or thyroid disease presented to the emergency department with simultaneous thyroid storm and diabetic ketoacidosis. Notable findings on admission were a ventricular rate of 235 beats/min, tachypnoea, tremors, polydipsia and a lack of fever. Due to the unusual constellation of symptoms, diagnosis was only possible after initial laboratory results came back. While the lack of fever is unusual in thyroid storm, diabetic ketoacidosis has previously been reported to suppress fever, and this case supports the occurrence of this phenomenon. This case was highly unusual because the patient had not previously been diagnosed with either type 1 diabetes or Graves’ disease.

Coexistence of diabetic ketoacidosis and thyrotoxicosis: a jeopardy of two endocrine emergencies

2021 ◽  
Vol 14 (6) ◽  
pp. e243534
Author(s):  
Soban Ahmad ◽  
Amman Yousaf ◽  
Shoaib Muhammad ◽  
Fariha Ghaffar
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Clinical Presentation ◽  
Early Recognition ◽  
Favourable Outcome ◽  
Adverse Outcomes ◽  
Thyroid Storm ◽  
Graves Disease ◽  
Thyroid Disorders ◽  
History Of

Simultaneous occurrences of diabetic ketoacidosis (DKA) and thyroid storm have long been known, but only a few cases have been reported to date. Both these endocrine emergencies demand timely diagnosis and management to prevent adverse outcomes. Due to the similarities in their clinical presentation, DKA can mask the diagnosis of thyroid storm and vice versa. This case report describes a patient with Graves’ disease who presented to the emergency department with nausea, vomiting and abdominal pain. He was found to have severe DKA without an explicit history of diabetes mellitus. Further evaluation revealed that the patient also had a concomitant thyroid storm that was the likely cause of his DKA. Early recognition and appropriate management of both conditions resulted in a favourable outcome. This paper emphasises that a simultaneous thyroid storm diagnosis should be considered in patients with DKA, especially those with a known history of thyroid disorders.

Frequency, clinical characteristics, biochemical findings and outcomes of DKA at the onset of type-1 DM in young children and adolescents living in a developing country – an experience from a pediatric emergency department

2019 ◽  
Vol 32 (2) ◽  
pp. 115-119 ◽  
Author(s):  
Amna Jawaid ◽  
Arjumand Sohaila ◽  
Nadia Mohammad ◽  
Unaib Rabbani
Keyword(s):  
Diabetes Mellitus ◽  
Emergency Department ◽  
Developing Countries ◽  
Type 1 Diabetes ◽  
Mortality Rate ◽  
Children And Adolescents ◽  
Diabetic Ketoacidosis ◽  
Clinical Characteristics ◽  
Incidence And Mortality

Abstract Background As per the International Society for Pediatrics and Adolescent Diabetes (ISPAD) census, diabetic ketoacidosis (DKA) is the most frequent cause of diabetes-related death. In developing countries, DKA-related mortality rate ranges from 6% to 24% (Onyiriuka AN, Ifebi E. Ketoacidosis at diagnosis of type 1 diabetes in children and adolescents: frequency and clinical characteristics. J Diabetes Metab Disord 2013;12:47) in contrast to 0.15%–0.31% in the Western world (Poovazhagi V. Risk factors for mortality in children with diabetic ketoacidosis from developing countries. World J Diabetes 2014;5:932–93.). In developing countries like Pakistan, the situation is more perplexing owing to uncertain or under-reported statistics about the spectrum of the disease and its prevalence, coupled with limited access to medical care and experts as well as less awareness. These limitations restrict our ability to develop interventions that are patient-centered. Our main objective was to determine the severity, clinical features, bio-chemical findings and outcomes of DKA in children aged 1 month to 16 years. Subjects and methods This retrospective study included the analysis of medical and laboratory records from patients’ medical charts and the electronic database of all children aged 1 month to 16 years with newly diagnosed type-1 diabetes mellitus (T1DM) complicated with ketoacidosis, who presented to the emergency department (ED) at the Aga Khan University Hospital (AKUH), between January 2009 and December 2014. Results Diabetes mellitus complicated with DKA was the predominant diagnosis (n=113 [75.83%]) among endocrine diseases in children visiting the ED. Our study witnessed an increase in the incidence of DKA particularly after 5 years of age, with more severity in females. In our study, the mortality rate was 3.4%. Conclusions Considering the high incidence and mortality rate, it is emphasized that DKA should be considered in differential diagnosis. An awareness campaign for both general pediatricians and physicians as well as for the public is needed for better outcomes.

scholarly journals Euglycemic Diabetic Ketoacidosis in Type 1 Diabetes on Insulin Pump, with Acute Appendicitis: A Case Report

2021 ◽  
Vol 5 (3) ◽  
pp. 296-298
Author(s):  
Brian Thompson ◽  
Anthony Kitchen
Keyword(s):  
Type 1 Diabetes ◽  
Case Report ◽  
Acute Appendicitis ◽  
Diabetic Ketoacidosis ◽  
Insulin Pump ◽  
Point Of Care ◽  
Altered Mental Status ◽  
History Of ◽  
Euglycemic Diabetic Ketoacidosis

Introduction: Recently, euglycemic diabetic ketoacidosis has been an increasing topic of discussion within emergency medicine literature. Euglycemic diabetic ketoacidosis can easily be missed, as a normal point-of-care glucose often mistakenly precludes the work-up of diabetic ketoacidosis. Case Report: A 16-year-old female with a past medical history of type 1 diabetes presented to the emergency department with altered mental status, vomiting, and abdominal pain. She was diagnosed with euglycemic diabetic ketoacidosis. Conclusion: Reported cases of euglycemic diabetic ketoacidosis are most frequently attributed to sodium glucose cotransporter-2 inhibitors, but other potential causes have been discussed in the literature. In this patient, a starvation state with continued insulin use in the setting of acute appendicitis led to her condition.

scholarly journals Type 1 Brugada pattern induced by DKA

2022 ◽  
Vol 6 (1) ◽  
pp. 01-02
Author(s):  
Drew Johnson
Keyword(s):  
Emergency Department ◽  
Heart Rate ◽  
Type 1 Diabetes ◽  
Abdominal Pain ◽  
Respiratory Rate ◽  
Past Medical History ◽  
History Of ◽  
Beta Hydroxybutyrate ◽  
Brugada Pattern

A 25-year-old man with a past medical history of type 1 diabetes presented to the emergency department with 2 days of progressive abdominal pain, nausea, and vomiting after stopping insulin. His heart rate was 125 and the respiratory rate was 26. The glucose was 832 mg/dl, the potassium was 6.6 mmol/L, the beta-hydroxybutyrate was 111.8 mg/dl, and the pH was 6.95.

scholarly journals Prevalence and Associated Factors of Diabetic ketoacidosis among Patients Living with Type 1 Diabetes in Makkah Al-Mukarramah City

2021 ◽  
Vol 20 (11) ◽  
Author(s):  
Raghad Alhajaji ◽  
Khalid Almasodi ◽  
Afaf Alhajaji ◽  
Ahmad Alturkstani ◽  
Mayada Samkari
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Hba1c Level ◽  
Past History ◽  
Postgraduate Education ◽  
Cross Sectional ◽  
Female Patients ◽  
History Of

Objective: To assess magnitude of diabetic ketoacidosis (DKA) among type-1 diabetics and to identify associated risk factors. Methods: A cross-sectional study was conducted among 236 type-1 diabetics in Makkah Al-Mukarramah City, Saudi Arabia. Results: Among participants, 59.3% were males, 44.1% were diabetic for more than 5 years, while 70.8% reported past history of DKA. The main causes of DKA were gfirst presentation of the diseaseh (40.9%), and gdiscontinued treatmenth (37%). The HbA1c among 53.6% was above 9%. Almost all cases who experienced DKA were hospitalised (98.8%). Out of them, 9 (5.4%) suffered complications. Female patients were more likely to suffer from episodes of DKA than males (76% and 68.3%, respectively). Most patients whose parentsf highest education was primary level had DKA more frequently than those whose parentsf had postgraduate education. Patients with unemployed fathers had significantly higher frequency of DKA (p=0.004). Ketoacidosis was significantly more frequent among patients with parentsf consanguinity (p<0.001). Patients who had their current HbA1c level exceeding 9% had positive history of DKA compared to those with HbA1c level .7% (87.9% and 28.6%, respectively, p<0.001). Conclusion: Most type-1 diabetics experience DKA, mainly with their first presentation of disease or due to discontinuation of treatment. DKA tends to occur more frequently among female patients, those with less educated parents or when their parents are relatives. Key words: Type 1 diabetes, diabetic ketoacidosis, magnitude, risk factors.

scholarly journals Diabetic Ketoacidosis and Mortality in People With Type 1 Diabetes and Eating Disorders

2021 ◽  
Author(s):  
Nicole K. Gibbings ◽  
Paul A. Kurdyak ◽  
Patricia A. Colton ◽  
Baiju R. Shah
Keyword(s):  
Eating Disorders ◽  
Type 1 Diabetes ◽  
Young Adults ◽  
Confidence Interval ◽  
Diabetic Ketoacidosis ◽  
Hazard Ratio ◽  
Adolescents And Young Adults ◽  
All Cause Mortality ◽  
History Of

Objective: To determine the risk of diabetic ketoacidosis (DKA) and all-cause mortality among adolescents and young adults with type 1 diabetes with and without an eating disorder. <p>Research Design and Methods: Using population-level healthcare administrative data covering the entire population of Ontario, Canada, all people with type 1 diabetes aged 10 to 39 as of January 2014 were identified. Individuals with a history of eating disorders were age/sex matched 10:1 with individuals without eating disorders. All individuals were followed for 6 years for hospitalization/emergency department visits for diabetic ketoacidosis, and for all-cause mortality.</p> <p>Results: We studied 168 people with eating disorders and 1680 age/sex-matched people without eating disorders. Among adolescents and young adults with type 1 diabetes, 168 (0.8%) had a history of eating disorders. The crude incidence of diabetic ketoacidosis was 112.5 per 1,000 patient-years in people with eating disorders, versus 30.8 in people without eating disorders. After adjustment for baseline differences, the subdistribution hazard ratio comparing people with and without eating disorders was 3.30 (95% confidence interval 2.58-4.23, p<0.0001). All-cause mortality was 16.0 per 1,000 person-years in people with eating disorders, versus 2.5 in people without eating disorders. The adjusted hazard ratio was 5.80 (95% confidence interval 3.04-11.08, p<0.0001). </p> <p>Conclusions: Adolescents and young adults with type 1 diabetes and eating disorders have more than triple the risk of diabetic ketoacidosis and nearly 6-fold increased risk of death compared to their peers without eating disorders.</p>

Severe Diabetic Ketoacidosis in a Child with Type-1 Diabetes, Asthma, and COVID-19

2020 ◽  
Author(s):  
Wilson A. Vasconez ◽  
Carmen L. Bustamante Escobar ◽  
Nisha Agarwal ◽  
Juan P. Solano ◽  
Janine E. Sanchez
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Insulin Infusion ◽  
Clinical Suspicion ◽  
Life Threatening ◽  
History Of ◽  
Novel Coronavirus

AbstractLittle is known about the association between novel coronavirus disease 2019 (COVID-19) and type-1 diabetes in children. A 16-year-old female with history of type-1 diabetes was admitted for life threatening diabetic ketoacidosis (DKA). She recovered from the DKA after 24 hours of insulin infusion and rehydration. On day 2, she was diagnosed with COVID-19. The DKA relapsed and required restarting insulin. She developed leukopenia, neutropenia, and high ferritin. Upon recovery she was discharged for self-quarantine. Severity of DKA in children with COVID-19 is multifactorial. Clinical suspicion of COVID should be heightened in patients who present with unexplainedly severe DKA.

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