A patient arrives at your internal medicine clinic. It is a young woman (23 yo) and she complains of abdominal pain, nausea, sore throat, and blurred vision since this morning. She attended a summer music festival and she admitted consuming a large amount of alcohol and use of methamphetamine IV.
She was diagnosed with type I diabetes at the age of 14. She self-administered her last dose of insulin yesterday evening, she missed her morning dose because she did not feel well, she did not eat, and vomited.
What is the most likely diagnosis of this patient?
The shortness of breath could indicate an inflammatory lung disease; however, damage of lung parenchyma is quite uncommon at this age. Nevertheless, it is important to bear in mind that any infection can trigger ketoacidosis in patients with type I diabetes.
You were presented with typical symptoms of absolute insulin deficiency
. This was probably augmented by dietary and regime missteps, or even by a stress such as physical effort, infection etc.
When the insulin-glucagon balance is tipped toward the glucagon side (e.g. by drug use), ketogenesis occurs. One of the main symptoms is hyperventilation, which helps the body to increase the pH. This breathing pattern is so typical in combination with MAC, that it even has its own name – Kussmaul breathing
The symptoms of acute abdomen can be imitated by pseudoperitonitis diabetica in patients with type II diabetes. Correction of the internal environment usually resolves this condition. We could examine the inflammatory markers to gain more information. It is also crucial to rule out ectopic pregnancy using hCG testing.
This condition occurs much more frequently in patients with type II diabetes. In that case, the deficiency of insulin leads to hyperglycemia, but its production is still partially present, which is enough to prevent ketogenesis.