ECE2021 Eposter Presentations Diabetes, Obesity, Metabolism and Nutrition (82 abstracts)
Boerhaave syndome and ’Diabetic Ketoalkalosis’ in a patient with type 1 diabetes mellitus: a case report
Maria Batool , Ashling Ni Chinneide , Roxana Tudor , Tommy Kyaw Tun , Seamus Sreenan , Mayilone Arumugasamy & John McDermott
Connolly Hospital Blanchardstown, Dublin, Ireland
A 20-year-old woman, with type 1 diabetes, presented to Emergency Department complaining of abdominal pain and vomiting for 3 days. She reported intermittent non-compliance with insulin therapy. Physical examination revealed epigastric tenderness. Blood glucose was 34.6 mmol/l, blood ketones 7.8 mmol/l, creatinine 131 µmol/l and CRP 31.47 mg/l (< 10). Despite clinical and initial laboratory features suggesting diabetic ketoacidosis, pH was 7.52 (7.32–7.43), pCO2 5.9 kPa (4.6–6.4), HCO3- 33.5 mmol/l (22–26), potassium 3.4 mmol/l (3.4–4.5), chloride 73 mmol/l (normal 98–107) and anion gap was 16. As the ketoacidosis improved with treatment, the woman complained of retrosternal burning pain. Chest X-ray suggested a pneumomediastinum, which was confirmed on CT thorax and barium swallow identified an oesophageal leak. A diagnosis of Boerhaave Syndrome was made. A laparoscopic esophagectomy and jejunostomy was successfully performed. We report a case of ’diabetic ketoalkalosis’, where gastrointestinal pathology with metabolic alkalosis masked an underlying diabetic ketoacidosis. Alkalosis in patients with DKA is a rare phenomenon. This is the first case to our knowledge of diabetic ketoalkalosis in the setting of Boerhaave syndrome. The metabolic alkalosis in this patient was a clue to the presence of significant underlying GI pathology, which ultimately required surgical intervention.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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