Endocrine Abstracts

Introduction: Diabetic ketoacidosis(DKA) is a serious acute complication of Diabetes mellitus that can be life - threatening. DKA is most common among people with type 1 diabetes. It is usually presented with hyperglicemia, ketoacidosis and presence of ketone bodies in the urine. Chronic diarrhea(CD) is defined as three or more loose stools daily for at least four weeks. There are many possible causes of chronic diarrhea. The most common causes are: Crohn disease & Ulcerative colitis (inflamatory diseases of gastrointestinal tract), malabsorption, endocrine diseases as hyperthyroidism, diabetic autonomic neuropathy, etc.

Case report: A 40-years old male was presented in emergency in serious condition, with tachycardia, shortness of breath, nausea and vomiting, diarrhea, fever, polyuria and polydipsia, etc. Medical history: Type 1 diabetes from 10 years, medical disorders treated with clonazepam and chronic diarrhea in the last year. He hadn’t take insulin for 3 days consequently. Labs: glycemia = 1757 mg/dl, urea = 117, kreatinine = 1.92, Ph = 6.74, BE= -33, Na⁺=106, K⁺= 8.5, CL^-=73, Troponin = neg, leukocytes = 21200 with left deviation of formula, ketone bodies in urine=50 mg/dl, INR = 1.45, hypoalbuminemia, etc. Treatment: intensive tratment with iv insuline, intensive rehydration with normal saline, sodium bicarbonate, sc enoxaparinë, iv Ampicillin, omeprazol, human albumin, elektrolites, vitamines, etc. 24-hours later all clinic and biochemical markers were normalized. Check up for the etiology of CD: TSH, FT3, FT4 in normal range, HbA1c=11%, normal thyroid and abdominal ultrasound, calprotectin fecal test = 245 mg/kg (>100 highly positive), fecal fats-positive, fecal ascarids-positive, elastic fibres-negative. Normal in Colonoscopy. Probably diabetic autonomic neuropathy diarrhea or Irritable bowl syndrome. After 9days he was discharged from the hospital in good condition with medications: insuline basal-bolus, probiotics, rifaximin 200 mg, and clonazepam. Follow up in 6 months: colonoscopy.

Conclusion: Regular treatment of Diabetes mellitus, especially type 1 diabetes, is very important. Missed doses of insuline can lead to complications like DKA. Comorbidity of diabetes and chronic diarrhea is fairly common. Diabetic patient have 2-4 fold probability to have CD than normal people. Patient with mental disorders are more prone to gastrointestinal problems.

Key words: Diabetic Ketoacidosis (DKA), Chronic Diarrhea (CD), Mental disorders.