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Acute esophageal necrosis complicating diabetic ketoacidosis in a patient with type II diabetes mellitus and excessive cola consumption: a case report

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Abstract

Acute esophageal necrosis (AEN) implicates poor tissue perfusion, functionally defective mucosal barrier, and corrosive injury of the esophageal mucosa, typically characterized by diffuse, circumferential greyish or black discoloration of the esophagus in esophagogastroduodenoscopy. Low-volume states, as diabetic ketoacidosis (DKA), predispose to AEN. Cola drinks diminish the esophageal pH by decreasing the lower esophageal sphincter pressure. We report a 47-year-old male shepherd with chest pain, nausea, odynophagia and gradual decline in level of consciousness, who reported consumption of 6–7 L of cola beverages per day, and was diagnosed with DKA. The patient had a record of type 2 diabetes mellitus and coronary heart disease, and he was administered empagliflozin 25 mg q24 hours, vildagliptin 50 mg bid, metformin 1000 mg bid, and insulin glargine 24 IU q 24. Esophagogastroduodenoscopy was indicative of a diffuse, edematous, and eroded mucosa of grey colour from the upper to the lower esophageal sphincter. CT scan supported the diagnosis, revealing diffuse thickening and edematous imaging of the esophageal wall with an abnormal edge of the mucosa in the lower half of the esophagus. Seven days after rigorous treatment with fluid resuscitation, insulin restoration, esomeprazole, fluconazole, cefoxitine, and metronidazole, the patient was ameliorated. A second endoscopy revealed obvious improvement. Pathophysiology, diagnosis, and treatment of DKA/AEN intertwining are thoroughly discussed. In conclusion, clinicians should not disregard AEN in the differential diagnosis of patients with DKA and clinical symptoms of esophagitis.

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Authors and Affiliations

  1. Department of Internal Medicine, Xanthi General Hospital, Neapoli, 67100, Xanthi, Greece

    Despoina Avramidou, Paraskevi Violatzi, Dimitra-Georgia Zikoudi, Anil Mourseloglou, Stefanos Panagaris, Eleni Metaxa, Anestis Partsalidis, Ioannis Feresiadis, Christakis Savva & Vasileios Papadopoulos

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  1. Despoina Avramidou
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  2. Paraskevi Violatzi
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  3. Dimitra-Georgia Zikoudi
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  4. Anil Mourseloglou
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  5. Stefanos Panagaris
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  6. Eleni Metaxa
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  7. Anestis Partsalidis
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  8. Ioannis Feresiadis
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  9. Christakis Savva
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  10. Vasileios Papadopoulos
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Correspondence to Vasileios Papadopoulos.

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Human rights statement and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (permission was obtained by the Xanthi General Hospital Scientific Committee-Decision No 104, May 17, 2021), as well as the Helsinki Declaration of 1964 and later version. Informed consent or substitute for it was obtained from the patient.

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Avramidou, D., Violatzi, P., Zikoudi, DG. et al. Acute esophageal necrosis complicating diabetic ketoacidosis in a patient with type II diabetes mellitus and excessive cola consumption: a case report. Diabetol Int 13, 315–319 (2022). https://doi.org/10.1007/s13340-021-00537-y

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