Unexpected Death during Treatment of Uncomplicated Diabetic Ketoacidosis

Unexpected Death during Treatment of Uncomplicated Diabetic Ketoacidosis Brit.med.1968, 4, 32-33 Ketotic coma accounts for only 1 % of deaths in diabetics (Entmacher and Marks, 1965), but the mortality of diabetic coma remains around 10% (Nabarro, 1965).The majority of those who die in diabetic coma do so of vascular or renal com- plications, but a small number die of uncomplicated ketosis which fails to respond to routine therapy.Recently there have been reports of young patients in diabetic ketosis who died after an initial improvement, both clinical and biochemical.FitzGerald et al. (1961) reported two cases and Young and Bradley (1967) a further two in which this course of events occurred and in which cerebral oedeema was found at necropsy.We report a case in which cerebral oedema developed during diabetic coma and which failed to respond to treatment. CASE REPORTA 28-year-old housewife was admitted to hospital as an emergency with a history of vomiting and dyspnoea for 24 hours.Diabetes mellitus had been diagnosed two years previously and she had been controlled with insulin zinc suspension and soluble insulin.On examination she was conscious but drowsy and dehydrated.Acetone was detectable in the breath and she was overbreathing.There were no other abnormal physical signs and no signs of infec- tion.Her blood pressure was 120/80 and her temperature 96' F.(35.6°C.).Laboratory data on admission included: blood sugar 490 mg./ 100 ml., alkali reserve 11 mEq/l., serum sodium 130 mEq/l., serum potassium 6.2 mEq/l., serum chloride 87 mEq/l., and blood urea 75 mg./100ml.Her plasma gave a strongly positive reaction for ketones and her urine contained 2% glucose and was strongly positive to Acetest tablets.Treatment was started with intravenous normal saline and sodium bicarbonate.She was given 100 units of soluble insulin intra- venously and during the first two hours had I litre of saline and 100 mEq of sodium bicarbonate.By this time her blood sugar had