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DIABETIC KETOACIDOSIS
Faculty of medicine, Department of internal medicine, National University of Malaysia,
Kuala Lumpur
Nurul Hashimah Abd Rashid.
ABSTRACT
A 32 years old Malay lady with background history of type I diabetes mellitus
presented to casualty complained of sudden onset shortness of breath
associated with vomiting and polyuria 1 day prior. On examination, she was alert
and conscious with Glasgow coma scale of 15/15, she was tachypnoiec, in
Kussmaul breathing, with rate of 32 breaths/minute. She was in metabolic
acidosis and was partially compensated with kussmaul breathing. Random blood
glucose showed 40 mmol/L and urine ketones showed 4+. She was diagnosed to
have diabetic ketoacidosis and recovered with fluid therapy and insulin. She will
continue her follow up at medical clinic in Hospital Teluk Intan.
KEYWORDS: diabetic ketoacidosis, type I diabetis mellitus, Kussmaul breathing.
INTRODUCTION:
Diabetic ketoacidosis (DKA) is acute,
major
life-threatening
sometimes
identified.
and
no
cause
can
be
absolute
deficiency
or
that
hyperglycaemic,
relative
will
acidosis
insulin
CASE REPORT:
produce
and
HN,
32
years
old
lady
with
with
requires
ketoacidosis
that
by
changing
posture.
It
was
advised
dextrostix
experienced
this
mmol/L
However there
is no paroxysmal
nocturnal
symptoms.
dypsnoea,
by
the
doctor
reading
that
when
showed
morning.
She
20
was
orthopnea,
no
suggest
home
frequent
she
fever
or
cough
long
to
travel
to
suggest
glucose
claimed
monitoring
that
her
which
dextrostix
has
family
member
vision
same
symptom.
lethargy
experienced
She
however
the
became
there
is
no
no
history
or
of
frothy
poor
urine.
wound
She
had
stabilisation.
more
day
day
Patient
admitted
than
also
10
times
denies
that
history
of
There
duration,
for
is
which
5
days
no
recent
she
was
duration,
discharged
and
insulin
denies taking
never
injection.
misses
She also
her
well.
intermenstrual
She
attained
bleeding
or
pressure
section in
is
96/53
which
is
abnormality
mmol/L
stroke
hypoxic,
or
heart
disease.
She
is
in
the
which
and
neurological
was
severe
bicarbonate
of 4.7.
was
ketoacidosis
because
metabolic
saturation
smoker
smokes
examination,
that
20cigarettes/day.
she
is
alert
On
and
with
diabetic
IV
sodium
and
she
was
having
acidosis.
also
severe
Oxygen
showed
that
the
with
first
insulin
not
no
pallor
Intan.
injection
lipodystrophic
or
conscious
diagnosed
sites
and
jaundice.
are
there
Her
is
mucous
24
hours
breath
noted.
She
is
DISCUSSION:
and
her
insulin
respiration,
breathing
with
heavy
with
high
anion
the
other
gap
and
hyperglycaemic
called
as
what
the
patient
the
non-ketotic
there
is
hyperglycaemia
acidosis,
in
causing
is
diabetes.
DKA
whenever
The
be
absent
experience
or
should
no
where
examiners
Kussmaul
possibility
considered
assessing
patient
of
usually
normal
Despite
or
high
at
is
essential
and
profile
DKA
that
can
present
who
fever
includes
results.
The
principle
insulin,
omitted
On
has
an
rate
of
output.
insulin
examination,
increased
the
depth
dose.
patient
and
potassium and
of
regimen
education.
suitable
for
diabetes.
Diabetes
Care.
2004;27(suppl 1):S94102.
. This is associated
3.
Harden,
Quinn,
Emergency
using
General
twice
Unnecessarily
these
large
rates.
volumes
Medicine,
Infirmary,
The
Leeds.
of
of cerebral oedema
. Volume status
4.
David
Trachtenbarg
M.D,
Medicine,
assessment
pressure,
(heart
state
rate,
of
blood
hydration),
and
urine
output.
rather
dextrose
may
than
isotonic
accelerate
the
Siperstein
MD.
Diabetic
Kitabchi
Murphy
AE, Umpierrez
MB,
Barrett
GE,
EJ,
crises
in
Peoria,
Illinois.