Highlights a rare presentation of massive pulmonary embolism triggered by the combination of diabetic ketoacidosis-induced hypovolemia and B12 deficiency-associated hyperhomocysteinemia.
Alerts clinicians to PE risk in combined DKA and B12 deficiency; case report leaves open causal synergy and need for confirmation.
A 57-year-old woman with no prior history was admitted to our emergency department with complaints of chest pain, dyspnea, xerostomia, syncope, and cyanosis on her lips and feet. On her physical examination, cyanosis, tachypnea, hypotension and sinus tachycardia were revealed. On the spiral computed tomography of the thorax of the patient with diabetic ketoacidosis, thrombus was detected in the left and right main pulmonary artery and segmental branches of the right pulmonary artery. The fibrinolytic treatment was initiated in the emergency department for the patient with hemodynamic shock due to the diagnosis of acute massive pulmonary embolism. Etiological examinations revealed B12 deficiency and hyperhomocysteinemia. This case, with the presentation of massive pulmonary embolism, resulted from the synergistic effect of hyperhomocysteinemia associated with B12 deficiency; hypovolemia caused by diabetic ketoacidosis was reported owing to its rareness.
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Üzmezoğlu et al. (2014) studied this question.
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