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Multiple complications in severe diabetic ketoacidosis. A short review of the literature

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Summary

Diabetic ketoacidosis may be associated with a wide variety of complications, some of which are uncommon and not widely appreciated. A case of severe ketoacidosis with multiple complications including septicaemia, pneumomediastinum, gastro-intestinal haemorrhage, magnesium depletion and multiple mononeuropathy is reported in a 17-year-old girl who made a successful recovery. The patient had not taken insulin for almost 4 days, had no preceding illness and was admitted in a near moribund state with hypothermia (34.2 °C), hypotension (80/50) and an arterial pH less than 6.8. There was a leukocytosis 41,200, the blood culture grew haemolytic streptococci and chest radiology showed pneumomediastinum. I.v. therapy was continued for some days and the patient developed clinical features of magnesium depletion. During the recovery period she developed multiple mononeuropathy. A brief review of these complications is given.

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References

  1. Abramson E., Arky R.: Diabetic Acidosis with Initial Hypokalemia. Therapeutic Implications — J. Amer. med. Ass.196, 401, 1966.

    Article  CAS  Google Scholar 

  2. Arky R. A., Hurwitz D.: Management of Emergencies. VII. The Therapy of Diabetic Ketoacidosis — New Engl. J. Med.274, 1135, 1966.

    Article  PubMed  CAS  Google Scholar 

  3. Atchley D. W., Loeb R. F., Dickinson W. R., Benedict F. M., Driscoll M. E.: On Diabetic Acidosis — J. clin. Invest.12, 297, 1933.

    PubMed  CAS  Google Scholar 

  4. Bagdade J. D., Nielson K., Root R. K., Bulger R. J.: Host Defense in Diabetes Mellitus: the Feckless Phagocyte During Poor Control and Ketoacidosis — Diabetes19 (Suppl. 1)), 364, 1970.

    Google Scholar 

  5. Bagdade J. D., Root R. K., Bulger R. J.: Impaired Leukocyte Function in Patients with Poorly Controlled Diabetes — Diabetes23, 9, 1974.

    PubMed  CAS  Google Scholar 

  6. Balch H. H., Watters M.: Blood Bacteriocidal Studies and Serum Complement in Diabetic Patients — J. surg. Res.3, 199, 1963.

    Article  PubMed  CAS  Google Scholar 

  7. Beigelman P. M.: Severe Diabetic Ketoacidosis (Diabetic ‘Coma’) — Diabetes20, 490, 1971.

    PubMed  CAS  Google Scholar 

  8. Beigelman P. M., Miller L. V., Martin H. E.: Mediastinal and Subcutaneous Emphysema in Diabetic Coma with Vomiting — J. Amer. med. Ass.208, 2315, 1969.

    Article  CAS  Google Scholar 

  9. Beigelman P. M., Warner N. E.: Thirty-Two Fatal Cases of Severe Diabetic Ketoacidosis, Including a Case of Mucormycosis — Diabetes22, 847, 1973.

    PubMed  CAS  Google Scholar 

  10. Brodribb H. S.: Pneumomediastinum and Diabetic Hyperpnoea — Brit. med. J.4, 773, 1968.

    PubMed  CAS  Google Scholar 

  11. Butler A. M.: Diabetic Coma — New Engl. J. Med.243, 648, 1950.

    Article  PubMed  CAS  Google Scholar 

  12. Butler A. M., Talbot N.B., Burnett C. H., Stanbury J. B., MacLachlen E. A.: Metabolic Studies in Diabetic Coma — Trans. Ass. Amer. Phycns60, 102, 1947.

    CAS  Google Scholar 

  13. Bybee J. D., Rogers D. E.: The Phagocytic Activity of Polymorphonuclear Leukocytes Obtained from Patients with Diabetes Mellitus — J. Lab. clin. Med.64, 1, 1964.

    PubMed  CAS  Google Scholar 

  14. Campbell I. W., Munro J. F., McCuish A. C., Duncan L. J. P.: Infection and Severe Diabetic Metabolic Decompensation — Practitioner213, 813, 1974.

    PubMed  CAS  Google Scholar 

  15. Chopra J. S., Hurwitz L. J., Montgomery D. A.: The Pathogenesis of Sural Nerve Changes in Diabetes Mellitus — Brain92, 391, 1969.

    Article  PubMed  CAS  Google Scholar 

  16. Cooper M. R., Turner R. A. Jr., Hutaff L., Prichard R.: Diabetic Keto-Acidosis Complicated by Disseminated Intravascular Coagulation — Sth. med. J. (Bgham, Ala.)66, 653, 1973.

    CAS  Google Scholar 

  17. Editorial: Infection and Diabetes — Brit. med. J.3, 76, 1974.

  18. Fageberg S. F.: Diabetic Neuropathy, a Clinical and Histological Study on the Significance of Vascular Affections — Acta med. Scand. (Suppl.)345, 1, 1959.

    Google Scholar 

  19. Fitzgerald M. G., O’Sullivan D. J., Malins J. M.: Fatal Diabetic Ketosis — Brit. med. J.1, 247, 1961.

    PubMed  Google Scholar 

  20. Gabbay K. H., O’Sullivan J. B.: The Sorbitol Pathway. Enzyme Localization and Content in Normal and Diabetic Nerve and Cord — Diabetes17, 239, 1968.

    PubMed  CAS  Google Scholar 

  21. Gilliatt R. W., Willison R. G.: Peripheral Nerve Conduction in Diabetic Neuropathy — J. Neurol. Neurosurg. Psychiat.25, 11, 1962.

    PubMed  CAS  Google Scholar 

  22. Girard D. E., Carlson V., Natelson E. A., Fred H. L.: Pneumomediastinum in Diabetic Ketoacidosis: Comments on Mechanism, Incidence and Management — Chest Dis. Index60, 455, 1971.

    CAS  Google Scholar 

  23. Greenbaum D.: Observations on the Homogeneous Nature and Pathogenesis of Diabetic Neuropathy — Brain87, 215, 1964.

    Article  PubMed  CAS  Google Scholar 

  24. Gregersen G.: Variations in Motor Conduction Velocity Produced by Acute Changes of the Metabolic State in Diabetic Patients — Diabetologia4, 273, 1968.

    Article  PubMed  CAS  Google Scholar 

  25. Grieve N. W., Bird D. R., Collyer A. J., Meredith G. A.: Pneumomediastinum and Diabetic Hyperpnoea — Brit. med. J.1, 186, 1969.

    PubMed  CAS  Google Scholar 

  26. Hamman L.: Spontaneous Interstitial Emphysema of the Lungs — Trans. Ass. Amer. Phycns52, 311, 1937.

    Google Scholar 

  27. Hart A., Cohen H.: Capillary Fragility Studies in Diabetes — Brit. med. J.2, 89, 1969.

    PubMed  CAS  Google Scholar 

  28. Hill H. R., Sauls H. S., Dettloff J. L., Quie P. G.: Impaired Leukotactic Responsiveness in Patients with Juvenile Diabetes Mellitus — Clin. Immunol. Immunopathol.2, 395, 1974.

    Article  PubMed  CAS  Google Scholar 

  29. Hirsch M. L.: Gastric Haemorrhage in Diabetic Coma — Diabetes9, 94, 1960.

    PubMed  CAS  Google Scholar 

  30. Joslin E. P., Root H. F., White P., Marble A.: Diabetic Coma — J. Amer. med. Ass.119, 1160, 1942.

    Google Scholar 

  31. Kirby A.: Diabetic Ketosis with Gross Hyperlipoproteinaemia and Followed by Severe Peripheral Neuropathy — Proc. roy. Soc. Med.65, 10, 1972.

    Google Scholar 

  32. Korczyn A. D.: Bell’s Palsy and Diabetes Mellitus — Lancet1, 108, 1971.

    Article  PubMed  CAS  Google Scholar 

  33. Kwaan H. C., Colwell J. A., Suwanwela N.: Disseminated Intravascular Coagulation in Diabetes Mellitus with Reference to the Role of Increased Platelet Aggregation — Diabetes21, 108, 1972.

    PubMed  CAS  Google Scholar 

  34. Larson D. L., Auchincloss J. H.: Multiple Symmetric Bilateral Cranial Nerve Palsies in Patients with Unregulated Diabetes Mellitus — Arch. intern. Med.85, 265, 1950.

    CAS  Google Scholar 

  35. Lawrence D. G., Locke S.: Neuropathy in Children with Diabetes Mellitus — Brit. med. J.1, 784, 1963.

    PubMed  Google Scholar 

  36. Maddison P. J., Baker L. R. I., Cattel W. R., Hopkins A. P.: Mononeuritis Multiplex Occurring in Diabetic Patient with Hb C Disease — Brit. med. J.2, 281, 1973.

    PubMed  CAS  Google Scholar 

  37. Martin H. E., Smith K., Wilson M. L.: The Fluid and Electrolyte Therapy of Severe Diabetic Acidosis and Ketosis; A Study of Twenty-Nine Episodes (Twenty-Six Patients) — Amer. J. Med.24, 376, 1958.

    Article  PubMed  CAS  Google Scholar 

  38. Martin H. E., Wertmann M.: Serum Potassium, Magnesium and Calcium Levels in Diabetic Acidosis — J. clin. Invest.26, 217, 1947.

    Article  PubMed  CAS  Google Scholar 

  39. Matz R.: Diabetic Coma, Guidelines in Therapy — N. Y. St. J. Med.74, 642, 1974.

    CAS  Google Scholar 

  40. McNicholl B., Murray J. P., Egan B., McHugh P.: Pneumomediastinum and Diabetic Hyperpnoea — Brit. med. J.4, 493, 1968.

    PubMed  CAS  Google Scholar 

  41. Mowat A., Baum J.: Chemotaxis of Polymorphonuclear Leukocytes from Patients with Diabetes Mellitus — New. Engl. J. Med.284, 621, 1971.

    Article  PubMed  CAS  Google Scholar 

  42. Mulder D. W., Calverley J. R., Miller R. H.: Autogenous Mononeuropathy; Diagnosis Treatment and Clinical Significance — Med. Clin. N. Amer.44, 989, 1960.

    PubMed  CAS  Google Scholar 

  43. Mulder D. W., Lambert E. H., Bastron J. A., Sprague R. G.: The Neuropathies Associated with Diabetes Mellitus — Neurology (Minneap.)11, 275, 1961.

    Google Scholar 

  44. Nabarro J. D. N., Spencer A. G., Stowers J. M.: Metabolic Studies in Severe Diabetic Ketosis — Quart. J. Med.21, 225, 1952.

    PubMed  CAS  Google Scholar 

  45. Perillie P. E., Nolan J. P., Finch S. C.: Studies of the Resistance to Infection in Diabetes Mellitus Local Exudative Response — J. Lab. clin. Med.59, 1008, 1962.

    PubMed  CAS  Google Scholar 

  46. Raff M. C., Asbury A. K.: Ischemic Mononeuropathy and Mononeuropathy Multiplex in Diabetes Mellitus — New Engl. J. Med.279, 17, 1968.

    Article  PubMed  CAS  Google Scholar 

  47. Robertson H. D., Polk H. C. Jr.: The Mechanism of Infection in Patients with Diabetes Mellitus; a Review of Leukocyte Malfunction — Surgery75, 123, 1974.

    PubMed  CAS  Google Scholar 

  48. Ruttley M., Mills R. A.: Subcutaneous Emphysema and Pneumomediastinum in Diabetic Keto-Acidosis — Brit. J. Radiol.44, 672, 1971.

    Article  PubMed  CAS  Google Scholar 

  49. Soler N. G., Bennett M. A., Fitzgerald M. G., Malins J. M.: Intensive Care in the Management of Diabetic Ketoacidosis — Lancet1, 951, 1973.

    Article  PubMed  CAS  Google Scholar 

  50. Tashima C. K., Reyes C. V., Kerlow A.: Mediastinal Emphysema in Diabetic Coma — J. Amer. med. Ass.209, 1720, 1969.

    Article  CAS  Google Scholar 

  51. Thomas P. K., Lascelles R. G.: The Pathology of Diabetic Neuropathy — Quart. J. Med.35, 489, 1966.

    Google Scholar 

  52. Timperley W. R., Preston F. E., Ward J. D.: Cerebral Intravascular Coagulation in Diabetic Ketoacidosis — Lancet1, 952, 1974.

    Article  PubMed  CAS  Google Scholar 

  53. Wallach S., Englert E., Jr., Brown H.: Adrenocortical Function in Diabetic Acidosis — Metabolism6, 107, 1957.

    PubMed  CAS  Google Scholar 

  54. Watkins P. J., Soler N. G., Fitzgerald M. G., Malins J. M.: Diabetic Ketoacidosis During the Influenza Epidemic — Brit. med. J.4, 89, 1970.

    PubMed  CAS  Google Scholar 

  55. Yanko L., Ticho U., Ivry M.: Optic Nerve Involvement in Diabetes — Acta ophthal. (Kbh)50, 556, 1972.

    Article  CAS  Google Scholar 

  56. Young E., Bradley R. F.: Cerebral Edema with Irreversible Coma in Severe Diabetic Ketoacidosis — New Engl. J. Med.276, 665, 1967.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Diabetic and Dietetic Department, The Royal Infirmary, EH3 9YW, Edinburgh, Scotland

    Basil F. Clarke & Ian W. Campbell

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  1. Basil F. Clarke
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Clarke, B.F., Campbell, I.W. Multiple complications in severe diabetic ketoacidosis. A short review of the literature. Acta diabet. lat 12, 327–337 (1975). https://doi.org/10.1007/BF02581105

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