Posters
Presentation Type
Poster
Discipline Track
Community/Public Health
Abstract Type
Case Report
Abstract
Euglycemic diabetic ketoacidosis (EDKA) is an underdiagnosed endocrine emergency. It consists of an increased anion gap metabolic acidosis (pH < 7.3 or serum bicarbonate < 18 mmol/L), moderate ketonuria with a blood glucose levels
The Patient is a 73-year-old female with a past medical history of Diabetes Mellitus, Hypertension, Hyperlipidemia, Hypothyroidism and deafness and muteness since birth. Patient had a recent ischemic stroke 5 days prior to the admission and was admitted at a different hospital for management of her stroke. Patient left against medical advice and presented to our ED later that day complaining of rectal prolapse. Of note, the patient is non-compliant with her medications. Upon admission, she is alert, oriented, and in acute distress. On her physical exam, her vital signs were within normal limits. Patient had a significant rectal prolapse with no other abnormalities seen on the exam. Lab values include glucose level of 170, Sodium of 135, HCO3 of 15, Chloride of 103, albumin level of 2.9, Anion Gap of 18, Corrected-albumin anion gap of 20.8. Her lactate level was 0.81. We obtained serum Ketones that resulted in a moderate elevation and her urinalysis showed Ketone +2. She presented no osmolar gap with a serum osmolality of 295. Her Hba1c was 12.9 and her Thyroid studies showed TSH level 32, T3 Uptake of 53.3, Total T4: 4.6 and a Free T4 0.56. Other causes of a high anion gap metabolic acidosis were ruled out and the patient was diagnosed with an EDKA.
EDKA is a diagnostic challenge as normal glucose level masks the underlying ketoacidosis. Therefore, a high index of suspicion is warranted. Altogether, our patient carries multiple risk factors for EDKA including poor oral intake, a recent stroke event and poorly controlled Diabetes Mellitus. Patient was hospitalized right before her admission and suspected to have received a long-acting insulin during her stay causing her to be euglycemic. Our patient was also admitted with severe hypothyroidism, it’s effect on development of EDKA is not well studied and suspected to also play a role in this patient’s presentation [2,3].
Academic/Professional Position
Resident
Mentor/PI Department
Internal Medicine
Recommended Citation
Gomez Casanovas, Jose Gerardo; Alshaikhli, Alfarooq; Saenz, Sergio; and Hernandez, Daniela, "Euglycemic Diabetic Ketoacidosis with a decompensated Hypothyroidism in the setting of a recent Cerebrovascular accident: A case report" (2023). Research Symposium. 4.
https://scholarworks.utrgv.edu/somrs/2022/posters/4
Included in
Euglycemic Diabetic Ketoacidosis with a decompensated Hypothyroidism in the setting of a recent Cerebrovascular accident: A case report
Euglycemic diabetic ketoacidosis (EDKA) is an underdiagnosed endocrine emergency. It consists of an increased anion gap metabolic acidosis (pH < 7.3 or serum bicarbonate < 18 mmol/L), moderate ketonuria with a blood glucose levels
The Patient is a 73-year-old female with a past medical history of Diabetes Mellitus, Hypertension, Hyperlipidemia, Hypothyroidism and deafness and muteness since birth. Patient had a recent ischemic stroke 5 days prior to the admission and was admitted at a different hospital for management of her stroke. Patient left against medical advice and presented to our ED later that day complaining of rectal prolapse. Of note, the patient is non-compliant with her medications. Upon admission, she is alert, oriented, and in acute distress. On her physical exam, her vital signs were within normal limits. Patient had a significant rectal prolapse with no other abnormalities seen on the exam. Lab values include glucose level of 170, Sodium of 135, HCO3 of 15, Chloride of 103, albumin level of 2.9, Anion Gap of 18, Corrected-albumin anion gap of 20.8. Her lactate level was 0.81. We obtained serum Ketones that resulted in a moderate elevation and her urinalysis showed Ketone +2. She presented no osmolar gap with a serum osmolality of 295. Her Hba1c was 12.9 and her Thyroid studies showed TSH level 32, T3 Uptake of 53.3, Total T4: 4.6 and a Free T4 0.56. Other causes of a high anion gap metabolic acidosis were ruled out and the patient was diagnosed with an EDKA.
EDKA is a diagnostic challenge as normal glucose level masks the underlying ketoacidosis. Therefore, a high index of suspicion is warranted. Altogether, our patient carries multiple risk factors for EDKA including poor oral intake, a recent stroke event and poorly controlled Diabetes Mellitus. Patient was hospitalized right before her admission and suspected to have received a long-acting insulin during her stay causing her to be euglycemic. Our patient was also admitted with severe hypothyroidism, it’s effect on development of EDKA is not well studied and suspected to also play a role in this patient’s presentation [2,3].