Severe diabetic ketoacidosis in combination with starvation and anorexia nervosa at onset of type 1 diabetes: A case report

Abstract We here report a case of diabetic ketoacidosis at onset of type 1 diabetes after a prolonged period of starvation due to anorexia nervosa. A 53-year-old female with a history of anorexia nervosa was admitted to the psychiatric clinic due to psychotic behaviour and inability to take care of herself. Twenty-four hours after admission she was transferred to the clinic of internal medicine due to altered mental status, and laboratory screening revealed a pH of 6.895 and blood glucose concentration of 40 mmol/L. Due to the unusual combination of prolonged starvation and diabetic ketoacidosis we implemented some modifications of existing treatment guidelines and some special considerations regarding nutrition in order to prevent a re-feeding syndrome.

[1]  K. Dhatariya,et al.  Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis , 2011, Diabetic medicine : a journal of the British Diabetic Association.

[2]  J. N. Fisher,et al.  Hyperglycemic Crises in Adult Patients With Diabetes , 2009, Diabetes Care.

[3]  R. Shih,et al.  Severe hyperglycemic hyperosmolar nonketotic coma in a nondiabetic patient receiving aripiprazole. , 2009, Annals of emergency medicine.

[4]  C. Apovian,et al.  The endocrinopathies of anorexia nervosa. , 2008, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[5]  D. Cooke,et al.  Management of diabetic ketoacidosis in children and adolescents. , 2008, Pediatrics in review.

[6]  M. Elia,et al.  Artificial nutrition support in hospital: indications and complications. , 2006, Clinical medicine.

[7]  C. Wetli,et al.  Fatal olanzapine-induced hyperglycemic ketoacidosis. , 2004, The American journal of forensic medicine and pathology.

[8]  A. Kitabchi,et al.  The use of alkali therapy in severe diabetic ketoacidosis. , 2002, Diabetes care.

[9]  J. Bertrand,et al.  Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? , 1999, Critical care medicine.

[10]  R. Casper.  Carbohydrate metabolism and its regulatory hormones in anorexia nervosa , 1996, Psychiatry Research.

[11]  C. Apovian,et al.  Guidelines for refeeding the marasmic patient , 1990, Critical care medicine.

[12]  D. Schocken,et al.  Weight loss and the heart. Effects of anorexia nervosa and starvation. , 1989, Archives of internal medicine.

[13]  A. Kitabchi,et al.  Bicarbonate therapy in severe diabetic ketoacidosis. , 1987, Annals of internal medicine.

[14]  G F Cahill,et al.  Brain metabolism during fasting. , 1967, The Journal of clinical investigation.