A Rare Complication of Diabetes Caused by Treatment

​BY WESTLEY REINHART MCMILLAN, DOA 34-year-old woman with a history of type 2 diabetes mellitus presented to the emergency department with achy abdominal pain, vomiting, and diarrhea for two days. She also reported decreased appetite, chills, and a productive cough. She was compliant with her diabetes medications, insulin, Jardiance, and Janumet.The patient was afebrile with a heart rate of 133 bpm and a blood pressure of 129/88 mm Hg. She had dry mucous membranes, and her abdomen was mildly tender in the epigastrum and upper quadrants but otherwise soft and not distended. Fingerstick glucose was 213 mg/dL. (Fig. 1.)Fig. 1. Fingerstick glucose revealing mild hyperglycemia.Initial blood work revealed a venous blood gas with a pH of 7.29 and an HCO3 of 15 (Fig. 2), and a basic metabolic panel showed an anion gap of 29 mEq/L (Fig. 3), consistent with anion gap metabolic acidosis. The patient was also noted to have significant glucosuria and ketonuria at more than 500 mg/dL and 80 mg/dL, respectively. (Fig. 4.) The patient's glucose was only mildly elevated, but the remainder of the workup was consistent with diabetic ketoacidosis. (Diabetes Care. 2009;32[7]:1335; http://bit.ly/31dMvkR.)Fig. 2. Basic chemistry revealing elevated anion gap and low CO2.Fig. 3. Venous blood gas revealing a low pH and low bicarbonate consistent with metabolic acidosis.Fig. 4. Urinalysis revealing profound glucosuria and accompanying ketonuria consistent with poor se...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research