Multiple Ischemic Infarctions, Pulmonary Edema, and Acute Renal Failure During an Episode of Diabetic Ketoacidosis in an Adult

Abstract

The morbidity and mortality associated with diabetic ketoacidosis (DKA) often reflects the precipitating events, such as myocardial infarction. However, DKA can trigger a systemic inflammatory response with the potential for multiple complications. This 30-year-old woman with type 1 diabetes mellitus improved within 48 hours of admission with a standard DKA treatment protocol. However, subsequent chest X-rays revealed bilateral infiltrates consistent with pulmonary edema; she then developed fever, hypotension, and acute-on-chronic renal failure. An altered level of consciousness prompted evaluation with neuroimaging, which revealed ischemic infarcts in the right frontal, parieto-occipital, and temporal cortices and cerebellum correlating with a left-sided hemiparesis. This case illustrates the potential complexity in the pathogenesis and management of patients with DKA. This patient likely had a systemic inflammatory response syndrome with multiorgan failure during this episode of DKA. Patients with DKA n...