SHM Converge Scientific Abstract ePoster Gallery-Diabetic Ketoacidosis Leading to Spinal Cord Infarction and Tetraplegia

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A 47-year-old woman with poorly controlled type 1 diabetes was found unresponsive after 24 hours of vomiting and presented in severe diabetic ketoacidosis (glucose 983, pH 6.8, bicarbonate 3, anion gap 37, potassium 7) complicated by shock, altered mental status, and pre-renal acute kidney injury. She required aggressive treatment with IV fluids, insulin, bicarbonate, and vasopressors in the ICU. Her glucose normalized after about 23 hours, and she became markedly fluid positive after resuscitation.<br /><br />On hospital day 3, she developed new numbness in the left upper extremity and both legs, progressing to absent movement and loss of sensation to light touch and temperature. Initial CT and brain MRI were negative, but spinal MRI suggested an intramedullary hemorrhage at C5. The differential included acute spinal ischemia and transverse myelitis, prompting transfer to a tertiary center. Despite high-dose steroids and five sessions of plasmapheresis, she showed little improvement. Lumbar puncture, serum studies, and neuromyelitis optica antibodies were negative. Follow-up MRI favored an acute/subacute spinal cord infarct.<br /><br />She was discharged to inpatient rehabilitation with persistent paraplegia/tetraplegia.<br /><br />The report emphasizes that spinal cord infarction is an extremely rare complication of diabetic ketoacidosis, with fewer than 10 adult cases reported. Proposed mechanisms include severe hypotension, rapid fluid shifts in a hyperosmolar state, hypoxia, and thrombosis, though the exact cause remains unclear. The authors recommend multidisciplinary evaluation of DKA patients to rule out mimics and highlight the need for better understanding of these rare but devastating neurologic complications.

Asset Subtitle

Nikita Piryani

Meta Tag

Author List Abhijai Singh, Nikita Piryani, Shivani Kumar

Category Clinical Vignettes

Concept Diabetic Ketoacidosis

Concept Spinal Cord Infarction

Concept Shock

Concept Anion Gap Metabolic Acidosis

Concept Fluid Therapy

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Nikita Piryani

Track Adult

Keywords

diabetic ketoacidosis

spinal cord infarction

type 1 diabetes

intramedullary hemorrhage

paraplegia

tetraplegia

acute spinal ischemia

plasmapheresis

neurologic complication

intensive care unit

Diabetic Ketoacidosis

Spinal Cord Infarction

Shock

Anion Gap Metabolic Acidosis

Fluid Therapy