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.

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.

scholarly journals Thromboembolic complications of thyroid storm

2014 ◽  
Vol 2014 ◽  
Author(s):  
T Min ◽  
S Benjamin ◽  
L Cozma
Keyword(s):  
Atrial Fibrillation ◽  
Early Recognition ◽  
Massive Pulmonary Embolism ◽  
Clinical Findings ◽  
Favourable Outcome ◽  
Thyroid Storm ◽  
List Type ◽  
Chads2 Score ◽  
Prompt Treatment ◽  
Life Threatening

Summary Thyroid storm is a rare but potentially life-threatening complication of hyperthyroidism. Early recognition and prompt treatment are essential. Atrial fibrillation can occur in up to 40% of patients with thyroid storm. Studies have shown that hyperthyroidism increases the risk of thromboembolic events. There is no consensus with regard to the initiation of anticoagulation for atrial fibrillation in severe thyrotoxicosis. Anticoagulation is not routinely initiated if the risk is low on a CHADS2 score; however, this should be considered in patients with thyroid storm or severe thyrotoxicosis with impending storm irrespective of the CHADS2 risk, as it appears to increase the risk of thromboembolic episodes. Herein, we describe a case of thyroid storm complicated by massive pulmonary embolism. Learning points Diagnosis of thyroid storm is based on clinical findings. Early recognition and prompt treatment could lead to a favourable outcome. Hypercoagulable state is a recognised complication of thyrotoxicosis. Atrial fibrillation is strongly associated with hyperthyroidism and thyroid storm. Anticoagulation should be considered for patients with severe thyrotoxicosis and atrial fibrillation irrespective of the CHADS2 score. Patients with severe thyrotoxicosis and clinical evidence of thrombosis should be immediately anticoagulated until hyperthyroidism is under control.

FAMILY HISTORY OF DIABETES IS ASSOCIATED WITH INCREASED RISK OF RECURRENT DIABETIC KETOACIDOSIS IN PEDIATRIC PATIENTS

2020 ◽  
Vol 26 (3) ◽  
pp. 305-311
Author(s):  
Janaki D. Vakharia ◽  
Sungeeta Agrawal ◽  
Janine Molino ◽  
Lisa Swartz Topor
Keyword(s):  
Diabetes Mellitus ◽  
Family History ◽  
Diabetic Ketoacidosis ◽  
Pediatric Patients ◽  
Incidence Rate Ratio ◽  
Family History Of Diabetes ◽  
Increased Risk ◽  
History Of

Objective: To determine the relationship between family history of diabetes mellitus (DM) and diabetic ketoacidosis (DKA) recurrence in youth with established type 1 diabetes mellitus (T1DM). Methods: We performed a retrospective chart review of patients with DKA admitted to a pediatric hospital between January, 2009, and December, 2014. We compared patients with recurrent (≥2 admissions) and nonrecurrent DKA (1 admission) and investigated patient level factors, including family history, that may be associated with DKA recurrence in pediatric patients with established T1DM. Results: Of the 131 subjects in the study, 51 (39%) subjects were in the recurrence group. Age ≥15 years old, public health insurance, and family history of T1DM or type 2 diabetes mellitus were associated with recurrent DKA admissions in both univariable and multivariable analyses. Family history was associated with DKA recurrence, with an incidence rate ratio of 1.5 (95% confidence interval = 1.0 to 2.3; P = .03). The association was not explained by type of familial diabetes, first degree relative status, or whether the family member lived in the household. Conclusion: Recognition that a positive family history of DM may be associated with a higher risk for DKA recurrence in patients with established T1DM may allow for targeted education and focus on a previously unidentified population at increased risk for DKA. Understanding the mechanism underlying the effect of family history of diabetes on the rates of DKA in patients with established T1DM may allow for improved identification and education of patients who may be at risk for DKA recurrence. Abbreviations: CI = confidence interval; DKA = diabetic ketoacidosis; EHR = electronic health record; IBD = inflammatory bowel disease; IRR = incidence rate ratio; T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus

scholarly journals Thyroid storm associated with Graves' disease covered by diabetic ketoacidosis: A case report

2011 ◽  
Vol 4 (1) ◽  
pp. 8 ◽  
Author(s):  
Erika Osada ◽  
Naoki Hiroi ◽  
Mariko Sue ◽  
Natsumi Masai ◽  
Ryo Iga ◽  
...  
Keyword(s):  
Case Report ◽  
Diabetic Ketoacidosis ◽  
Thyroid Storm ◽  
Graves Disease

scholarly journals Diabetic Ketoacidosis With Alpelisib

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A376-A377
Author(s):  
Rebecca Jeun ◽  
Victor Ralph Lavis ◽  
Sonali Thosani
Keyword(s):  
Breast Cancer ◽  
Diabetes Mellitus ◽  
Metastatic Breast Cancer ◽  
Diabetic Ketoacidosis ◽  
Hormone Receptor ◽  
Previous History ◽  
Metastatic Breast ◽  
Laboratory Evaluation ◽  
Hormone Receptor Positive ◽  
History Of

Abstract Background: Hyperglycemia is a frequently reported adverse effect of alpelisib, an isoform specific phosphoinositide 3 kinase inhibitor, which is recently approved for use in hormone receptor positive advanced or metastatic breast cancer. Though two patients in clinical trials with alpelisib developed diabetic ketoacidosis (DKA), there have been no case reports to date characterizing this complication after drug approval. We present the first case of DKA in patients on alpelisib therapy. Clinical Case: A 55-year-old woman with a history of hormone-receptor positive metastatic breast cancer was started on treatment with fulvestrant and alpelisib. The patient did not have any previous history of diabetes nor gestational diabetes, though she had evidence of prediabetes prior to starting treatment. Patient was non-obese and had a family history of type 2 diabetes. Baseline hemoglobin A1c was 5.6% (n <5.7%) with impaired fasting glucose of 108 mg/dl (n<105 mg/dL) immediately prior to starting therapy. One week after starting alpelisib, she presented to the emergency center in diabetic ketoacidosis. Initial laboratory evaluation showed serum glucose 690 mg/dl, anion gap metabolic acidosis, with undetectable serum bicarbonate and ketonuria. C-peptide on hospital day 1 was found to be 2.8 ng/ml (n 0.5 - 3.4 ng/ml) with a concurrent glucose of 479 mg/dl. GAD65 and Islet Antigen 2 antibodies were negative. Diabetic ketoacidosis quickly resolved with continuous insulin infusion and stopping alpelisib. The patient was able to come off all insulin therapy prior to discharge and was discharged on metformin with adequate glycemic control. Conclusions: Current manufacturer guidelines for alpelisib recommend screening for diabetes mellitus at baseline and monitoring blood glucose and/or fasting plasma glucose weekly for the first two weeks of treatment and monthly thereafter. However, patients with no pre-existing history of diabetes mellitus may be at risk for life-threatening hyperglycemic crises which may develop within a week of initiation of alpelisib and more frequent monitoring may be indicated. The hyperglycemic effect of alpelisib appears to be reversible upon stopping the drug.

Presentation of mixed diabetic ketoacidosis and metabolic acidosis due to ileal neobladder reconstruction

2021 ◽  
Vol 14 (2) ◽  
pp. e223668
Author(s):  
Dileep Kumar ◽  
Muhammad Zubair Nasim ◽  
Bilal Ahmad Shoukat ◽  
Syed Shabahat Ali Shah
Keyword(s):  
Diabetes Mellitus ◽  
Metabolic Acidosis ◽  
Diabetic Ketoacidosis ◽  
Plasma Glucose ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Anion Gap ◽  
Metabolic Complications ◽  
Ileal Neobladder ◽  
History Of

Diabetic ketoacidosis (DKA) is one of the most serious acute metabolic complications of diabetes mellitus. It is characterised by the biochemical triad of hyperglycaemia, ketonemia/ketonuria, and an increased anion gap metabolic acidosis. In this case, a 40-year-old male patient presented to the emergency department, with vomiting, nausea, polydipsia, polyuria and weight loss. He was found to have an elevated plasma glucose, despite having no known history of diabetes mellitus. His medical history was significant for spina bifida and ileal neobladder reconstruction. The plasma glucose level was 38 mmol/L. Blood gas analysis showed normal anion gap metabolic acidosis with high chloride and low bicarbonate. His plasma ketone level was 4.5 mmol/L. No significant reason for hyperchloraemia was identified. On initiation of DKA regimen, his condition improved and serum ketones normalised. Due to persistent hyperchloraemic metabolic acidosis, bicarbonate infusion was administered and his metabolic acidosis resolved.

scholarly journals Posttransplant Tacrolimus-Induced Diabetic Ketoacidosis: Review of the Literature

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Zaid Ammari ◽  
Stella C. Pak ◽  
Mohammed Ruzieh ◽  
Osama Dasa ◽  
Abhinav Tiwari ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Adverse Event ◽  
Kidney Transplantation ◽  
Diabetic Ketoacidosis ◽  
Autosomal Dominant ◽  
Immunosuppressive Regimen ◽  
Review Of The Literature ◽  
Polycystic Kidney ◽  
History Of ◽  
Autosomal Dominant Polycystic Kidney

Diabetic ketoacidosis (DKA) in patients receiving tacrolimus as part of their immunosuppressive regimen is a rarely reported adverse event. We report a patient with autosomal dominant polycystic kidney disease (ADPKD) and no known history of diabetes mellitus who presented with DKA, 3 months after kidney transplantation.

scholarly journals Macrosomia is a risk factor for incident maternal chronic kidney disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammad Vahidi ◽  
Samaneh Asgari ◽  
Maryam Tohidi ◽  
Fereidoun Azizi ◽  
Farzad Hadaegh
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Reference Group ◽  
Significant Risk ◽  
Adverse Outcomes ◽  
Prior History ◽  
Family History Of Diabetes ◽  
History Of ◽  
Study Population

Abstract Background Gestational diabetes mellitus (GDM) and macrosomia are associated with several adverse outcomes including diabetes mellitus and cardiovascular diseases, however, the relationship between GDM/macrosomia with incident chronic kidney disease (CKD) is a matter of debate. The purpose of this study was to examine the association between the history of macrosomia with or without GDM and incident maternal CKD. Methods The study population includes 2669 women aged 18–50 years without known diabetes mellitus and CKD from participants of the Tehran Lipid and Glucose Study. The study population was categorized into 3 groups; group 1: GDM/macrosomia and without diabetes mellitus (n = 204), group 2: newly diagnosed incident diabetes mellitus (NDM) in the presence or abcence of GDM/Macrosomia (n = 113), and, group 3: the reference group including women without prior history of GDM/macrosomia and free of NDM (n = 2352). CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2. Multivariable Cox proportional hazard regression adjusted for baseline values of age, body mass index, waist circumference, parity numbers, smoking, educational level, gestational hypertension, eGFR, systolic and diastolic blood pressures (SBP and DBP, respectively), anti-hypertensive medication, and family history of diabetes mellitus was applied for data analyses. Results During a median follow-up of 11.9 years, 613 incident CKD cases were identified. The multivariable hazard ratio (HR) and 95% confidence interval (CI) on GDM/macrosomia group was [1.32 (1.02–1.72)]; the risk was more prominent among non-hypertensive women [1.41 (1.07–1.85); P for interaction: 0.046]. Moreover, the history of macrosomia alone also showed a significant risk [1.36 (1.04–1.78)]; however, history of GDM alone did not have a significant risk [0.92 (0.34–2.46)]. Age, current smoking, eGFR, and SBP remained as independent risk factors for incident CKD. Conclusions A history of GDM/macrosomia or macrosomia alone, independent of subsequent diabetes mellitus was associated with significant risk for incident maternal CKD. Pregnancy may provide a unique situation to identify high-risk women at risk for CKD that could benefit from regular monitoring of kidney function and providing risk modifying strategies.

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