SHM Converge Scientific Abstract ePoster Gallery-An Enigmatic Case of Diabetic Ketoacidosis

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This case describes a 58-year-old man with prediabetes, prior pulmonary embolism, and a history of colon cancer who presented with dyspnea, altered mental status, fever, abdominal distension, severe tachypnea with Kussmaul respirations, hypoxia, and acute renal failure. He was initially managed with BiPAP and admitted to the ICU.<br /><br />Imaging showed severe acute pancreatitis on CT abdomen/pelvis. Gallstones were absent on ultrasound and ethanol level was negative. He was diagnosed with diabetic ketoacidosis (DKA) in the setting of severe pancreatitis. Treatment included IV insulin and aggressive fluids, but he developed distributive shock with worsening mental status, requiring intubation, vasopressors, continuous renal replacement therapy (CRRT), and empiric antibiotics. Infectious work-up was negative, antibiotics were stopped, and he gradually improved with insulin and volume resuscitation, eventually being extubated.<br /><br />The key clinical question was the direction of causality: did pancreatitis cause DKA/new diabetes, or did DKA cause pancreatitis? Literature suggests both are plausible. Meta-analyses show that new diabetes can develop after acute pancreatitis, especially after severe episodes. Conversely, DKA can cause acute pancreatitis, often through severe hypertriglyceridemia due to insulin deficiency and impaired lipoprotein lipase activity. This triad of DKA, hypertriglyceridemia, and pancreatitis is associated with worse outcomes, including multi-organ failure and higher inpatient mortality.<br /><br />Overall, the case highlights a rare and severe presentation of DKA complicated by acute pancreatitis and multi-organ dysfunction, emphasizing the importance of aggressive supportive care and careful evaluation of the underlying cause.

Asset Subtitle

Steven A. Lewis

Meta Tag

Author List Mikhaila Smith-Wilkerson, Steven A. Lewis, Vaishnavi Lanka

Category Clinical Vignettes

Concept Diabetic Ketoacidosis

Concept Acute Pancreatitis

Concept Insulin Deficiency

Concept Multiorgan Dysfunction

Concept Continuous Intravenous Insulin Therapy

Distinguished Non-Finalist

Presenter Organization Emory University School of Medicine Internal Medicine Residency Program

Presenting Author Steven A. Lewis

Track Adult

Keywords

diabetic ketoacidosis

acute pancreatitis

hypertriglyceridemia

multi-organ failure

acute renal failure

distributive shock

ICU admission

insulin therapy

severe pancreatitis

Kussmaul respirations

Diabetic Ketoacidosis

Acute Pancreatitis

Insulin Deficiency

Multiorgan Dysfunction

Continuous Intravenous Insulin Therapy