Endocrine Abstracts

Diabetic ketoacidosis (DKA) is one of the most serious complications of diabetes mellitus (DM). We describe 2 cases of type-2 diabetic patients admitted by a surgical reason/trauma in which DM control was neglected. We present a 74-year-old patient with poor metabolic control (HbA1c 7,6%) treated with metphormin, sitagliptin and glibenclamide, admitted for orthopaedic surgery. During hospitalization, there were noted several episodes of disorientation with hyperglycaemia about 300-350 mg/dl. At day 6, the patient was prostrated and with a glucose over 500 mg/dl and metabolic acidosis (pH 7,34; pCO₂ 29 mmHg; pO₂ 89 mmHg; HCO₃ 15,6 mmol/l; lactate 8 mg/dl). Because of DKA, the patient was transferred to an Intermediate Care Unit (IntCU), where it was begun fluids and insulin perfusion, with great response. Simultaneously, we present a case of a 70-year-old patient, already with diabetic retinopathy, treated with insulin, metphormin and sitagliptin, that was admitted because of a pneumothorax and 3 broken ribs after a fall. She was admitted in Pneumology ward, maintaining hyperglycemias, nauseas and vomiting. At day 8, she was found prostrated, frankly dehydrated and with a hyperglycaemia over 500 mg/dl. After diagnosing DKA with a serious metabolic acidosis (pH 6,97; pCO₂ 8 mmHg; pO₂ 106 mmHg; HCO₃ 3 mmol/l; lactates 31 mg/dl), she was transferred to IntCU, where she was treated with fluids and insulin, with good posterior metabolic control. In both cases, the patients presented had the DM diagnosis, being treated accordingly at home. Although, after being admitted for an unrelated reason, it was neglected all DM control as well as the symptoms that came from its decompensation, ending in an extremely serious state. This reinforces the need of approaching each patient with all its conditions, reassuring the essential role of Internal Medicine in management and orientation of these patients since their admission.