Diabetic Ketoacidosis–Associated Brain Injury: A Rare but Serious Complication

Diabetic ketoacidosis (DKA)-associated brain injury is a rare but serious complication, typically occurring early during metabolic correction and associated with a poor prognosis. We report the case of an 18-year-old college student admitted to the intensive care unit with severe DKA, characterized by profound metabolic acidosis and marked electrolyte imbalances, including hypokalemia, hypernatremia, and hyperchloremia. Within hours, she developed altered mental status and generalized seizures. Brain magnetic resonance imaging (MRI) revealed diffuse cortical and brainstem abnormalities, suggestive of cytotoxic cerebral edema. She was managed with continuous sedation, mechanical ventilation, intravenous insulin, potassium supplementation, enteral nutrition, and gradual metabolic correction. Her neurologic status improved within a few days, and follow-up MRI showed partial regression of the lesions. She was subsequently transferred to the endocrinology department and ultimately regained full cognitive and physical function. This case underscores the importance of early recognition, close neurologic monitoring, timely neuroimaging, and tight metabolic and osmotic control to optimize outcomes in patients with DKA-associated brain injury.