ESPE Abstracts

Background: Diabetic Ketoacidosis (DKA) is a serious and common complication of type 1 diabetes mellitus. Often it occurs due to non-compliance of the patient’s insulin regimen, especially of the basal insulin. In this patient, about 6 months after being diagnosed, she presented to the emergency department in DKA, with a pH of 6.9 with altered mental status, which required intubation for 1 week. She was treated with an IV insulin drip and fluids. As a result of her management, she developed tracheal stenosis and cerebral edema. She also developed right hand monoplegia and has not regained full function, despite physical therapy. As a result of her stenosis, she developed stridor on exertion and had to be admitted to the hospital on four different occasions for tracheal dilation. After this failed, a tracheoplasty was done by cardiothoracic surgery. On follow up, a fasting lipid panel was done and the triglyceride value was >3000 mg/dl. She was then started on 600 mg twice daily of Gemfibrozil. After following up on the phone, she did admit that she was not compliant with her insulin regimen and Gemfibrozil. After 1 week, she presented to the hospital with abdominal pain and vomiting. A serum lipase was elevated at 500 U/l. She was admitted and kept NPO for 1 day and her abdominal pain improved. An abdominal ultrasound was consistent with acute pancreatitis. After in-patient management, her triglyceride level decreased to 200 mg/dl and her lipase levels normalized in 2 days.

Objective and hypotheses: Diabetic ketoacidosis is a serious complication of type 1 diabetes mellitus, which can cause severe morbidity and uncommon complications like tracheal stenosis. Also uncontrolled diabetes mellitus can cause complications from hypertriglyceridemia, like acute pancreatitis.

Method: We examined a 14 year old female with a known history of type 1 diabetes mellitus for 1 year through chart review.

Results: This is a 14 year old female who developed serious acute complications from type 1 diabetes mellitus, including tracheal stenosis, which required tracheoplasty, cerebral edema, monoplegia of her hand, and subsequently acute pancreatitis.

Conclusion: Proper management of type 1 diabetes mellitus is needed to avoid serious complications from DKA and from hypertriglyceridemia, like acute pancreatitis.