Diabetic Ketoacidotic Coma. Analysis of Clinical Case and Literature Review

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Tue, 2018/10/23 - 10:47
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Laboratorinė medicina. 2018,
t. 20,
Nr. 2,
p. 146 -
153

Introduction. Diabetic ketoacidosis (DKA) is one of the most serious acute complications of diabetes mellitus (DM), asociated with hyperglikemia, ketonemia and metabolic acidosis with an increased anion gap. It is important to manage all pathways of DKA pathogenesis: volemia, sodium and potassium serum concentration, glycemia, ketonemia and acidosis. The aims of this work: analyse DKA management strategy and recommend how to improve management of patients with DKA according to the latest guidelines.

Case report. We describe the case of a 28-year-old woman with insulin-dependent diabetes. The patient had a food poisoning few days ago, she vomited and do not eat for last three days. She was admitted to the intensive care unit with dehydration, hypovolemia and disorientation, hyperglycemia (glucose - 35.4 mmol/L), metabolic acidosis and respiratory alkalosis (pH - 6.742, pCO2 - 10.0 mmHg, HCO3" - 1.3 mmol/L,); electrolyte disbalanse: potassium - 5.17 mmol/L, sodium - 120 mmol/L, chlo­ride - 86 mmol/L. Patient was treated with iniusions of sodium chloride 0.9%, Ringer acetate, sodium bikarbonate 4.2%, and continuous insulin infusion (starting with 4.5 U/h). Consciousness and microcirculation improved on day 2, but unstable      glycaemia (4.29-21.1 mmol/L) and polydipsia still existed. Patient was transierred to the department of internal diseases on day 6th.

Conclusions. DKA management strategy helped to corect glycemia and metabolic abnormalities in our patient. Nevertheless it would be possible to improve our treatment results, avoid complications and decrease lenth of hospital stay, if DKA patients will be managed according to the latest DKA guidlines.

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