{"title":"An elderly patient with dementia presenting euglycaemic ketoacidosis due to oesophageal stricture-associated eating habits.","authors":"Hiroaki Iwasaki, Seie Morita","doi":"10.1093/omcr/omae187","DOIUrl":null,"url":null,"abstract":"<p><p>An 85-year-old man with dementia was referred to our department because of problematic eating habits, which made it difficult to manage his diabetes mellitus. The patient exhibited euglycaemic ketoacidosis, with a clinical course and biochemical parameters more indicative of starvation ketoacidosis rather than diabetic ketoacidosis. After correcting the acid-base imbalance with dextrose-containing fluids, he attempted to resume oral intake; however, throat noises consistent with reflux were noted during food ingestion. Imaging and pathological studies revealed a stricture with wall thickening in the mid-oesophagus attributed to non-specific chronic oesophagitis. After receiving hypercaloric fluids to calm oesophageal inflammation, an endoscopic bougienage was performed, enabling oral intake and achieving appropriate glycaemic control with oral glucose-lowering agents. This case illustrates the importance of closely monitoring eating behaviours, which is crucial for identifying comorbid organic abnormalities, without being limited by cognitive bias in clinical reasoning that problematic dietary changes are highly prevalent in dementia patients.</p>","PeriodicalId":45318,"journal":{"name":"Oxford Medical Case Reports","volume":"2025 2","pages":"omae187"},"PeriodicalIF":0.5000,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845346/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Oxford Medical Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/omcr/omae187","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
An 85-year-old man with dementia was referred to our department because of problematic eating habits, which made it difficult to manage his diabetes mellitus. The patient exhibited euglycaemic ketoacidosis, with a clinical course and biochemical parameters more indicative of starvation ketoacidosis rather than diabetic ketoacidosis. After correcting the acid-base imbalance with dextrose-containing fluids, he attempted to resume oral intake; however, throat noises consistent with reflux were noted during food ingestion. Imaging and pathological studies revealed a stricture with wall thickening in the mid-oesophagus attributed to non-specific chronic oesophagitis. After receiving hypercaloric fluids to calm oesophageal inflammation, an endoscopic bougienage was performed, enabling oral intake and achieving appropriate glycaemic control with oral glucose-lowering agents. This case illustrates the importance of closely monitoring eating behaviours, which is crucial for identifying comorbid organic abnormalities, without being limited by cognitive bias in clinical reasoning that problematic dietary changes are highly prevalent in dementia patients.
期刊介绍:
Oxford Medical Case Reports (OMCR) is an open access, peer-reviewed online journal publishing original and educationally valuable case reports that expand the field of medicine. The journal covers all medical specialities including cardiology, rheumatology, nephrology, oncology, neurology, and reproduction, comprising a comprehensive resource for physicians in all fields and at all stages of training. Oxford Medical Case Reports deposits all articles in PubMed Central (PMC). Physicians and researchers can find your work through PubMed , helping you reach the widest possible audience. The journal is also indexed in the Web of Science Core Collection . Oxford Medical Case Reports publishes case reports under the following categories: Allergy Audiovestibular medicine Cardiology and cardiovascular systems Critical care medicine Dermatology Emergency medicine Endocrinology and metabolism Gastroenterology and hepatology Geriatrics and gerontology Haematology Immunology Infectious diseases and tropical medicine Medical disorders in pregnancy Medical ophthalmology Nephrology Neurology Oncology Paediatrics Pain Palliative medicine Pharmacology and pharmacy Psychiatry Radiology, nuclear medicine, and medical imaging Respiratory disorders Rheumatology Sexual and reproductive health Sports Medicine Substance abuse.