An extremely rare case of diabetic ketoacidosis requiring endotracheal intubation in a type 2 diabetic patient secondary to antipsychotic drug.
Serdar Olt1, Mehmet Sarıaydın1
1 Medical Faculty Department of Internal Medicine, Adıyaman University, Turkey.
Corresponding author: Serdar Olt
Address: Altınşehir Mahallesi, Atatürk Blv. No.1, 02040 Adıyaman Merkez/Adıyaman, Turkey;
Telephone: +905307774064; E-mail: serdarolt84@yahoo.com
Abstract
A 60-year-old male patient was admitted due to sudden loss of consciousness. The patient was unconscious, Glasgow Coma Scale had a score of 4 and the skin turgor tonus turned out to be reduced in the physical examination. Other physical examination findings were normal. Biochemical analysis of blood glucose revealed a value of 407 mg/dl. Arterial blood gas examination revealed that pH was: 7.13, PaO2 was: 41.5 mm Hg, PaCO2 was: 46.7 mm Hg and HCO3 was: 15.6mEq/L.2. Positive ketonuria was detected in urinalysis. The patient was intubated and mechanical ventilation support was given because of the low Glasgow Coma Scale.
The patient was diagnosed with diabetic ketoacidosis and admitted to intensive care unit. Patient’s acidosis and ketonuria were recovered after medical treatment and subsequently the patient was discharged with oral antidiabetics.
In diabetic patients, ketoacidosis dependent on antipsychotic drugs is extremely rare and a fatal condition. A very small proportion of cases of diabetic ketoacidosis require intubation. Herein we want to emphasize a very rare condition that develops secondary to antipsychotic drugs.
Keywords: antipsychotic drugs, diabetes mellitus, diabetic ketoacidosis.
Introduction
Diabetic ketoacidosis is one of the most important conditions and could be a fatal endocrine emergency (1,2). Rapid diagnosis and treatment of the patients reduces mortality rates. Unlike other acute diabetic complications, ketoacidosis is often a condition which may be missed when the patient’s consciousness is normal because of the lack of urine tests and blood gas analysis. Rarely, this condition can make changes of the consciousness.
We aimed to present a case of diabetic ketoacidosis due to antipsychotic medication which was requiring endotracheal intubation.
Case report
A 60-year-old male patient was admitted due to sudden loss of consciousness. The patient was using oral antidiabetic and antipsychotic for diabetes and schizophrenia, respectively. The patient was using oral antidiabetic drugs irregularly. The patient was unconscious, the Glasgow coma scale had a score of 4 and the skin turgor tonus was reduced in the physical examination. Other physical examination findings were normal. Biochemical analysis of blood glucose revealed 407 mg/dl. Arterial blood gas examination revealed that pH was: 7.13, PaO2 was: 41.5 mm Hg, PaCO2 was: 46.7 mm Hg and HCO3 was: 15.6 mEq/L. Positive ketonuria was detected in urinalysis. The patient’s laboratory results are summarized in Tables 1-3. The patient was intubated and mechanical ventilation support was given because of the low Glasgow coma scale.
Table 1. The patient’s urinalysis results
Table 2. The patient’s laboratory values
Table 3. The patient’s blood gas results
The patient was diagnosed with diabetic ketoacidosis and admitted to intensive care unit. Insulin infusion and fluid therapy was started. The patient’s consciousness came to normal with the treatment. Patient’s acidosis and ketonuria were recovered, then the patient was discharged with oral antidiabetics.
Discussion
Diabetes mellitus is one of the most common chronic diseases in the world, and affects the sustainable employability (3). There is insulin deficiency or insulin resistance in the pathogenesis of diabetes mellitus. Type 2 diabetes mellitus, which begins with insulin resistance, is a preventable disease (4). There are many causes of diabetes mellitus. Taking antipsychotic drugs is a rare cause of type 2 diabetes mellitus (5).
Diabetic ketoacidosis is one of the most important and fatal endocrine emergencies. Rapid diagnosis and treatment of the patients reduce mortality rates.
Unlike other acute complications, diabetic ketoacidosis is often a condition that can be missed if the patient’s consciousness is clear and blood gas and urine are not examined. But, in rare cases it can make changes in consciousness that can reach the coma. In diabetic patients, ketoacidosis is extremely rare and may be fatal condition. A very small proportion of cases with diabetic ketoacidosis require endotracheal intubation.
Our case study highlights a very rare condition that develops secondary to antipsychotic drug.
Conflict of interest: None declared.
References
1. Fayfman M, Pasquel FJ, Umpierrez GE. Management of hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Med Clin North Am 2017;101:587-606.
2. Umpierrez G, Korytkowski M. Diabetic emergencies – ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol 2016;12:222-32.
3. Ploeg L, Czabanowska K, Burazeri G. Diabetes and sustainable employability: A qualitative study. Alban Med J 2017;1:7-16.
4. Olt S. Creating active living habitats for the prevention of type 2 diabetes and obesity: A health project. Alban Med J 2018;1:9-10.
5. Whicher CA, Price HC, Holt RI. Mechanisms in endocrinology: Antipsychotic medication and type 2 diabetes and impaired glucose regulation. Eur J Endocrinol 2018;178:R245-58.