Steroid-Induced Diabetic Ketoacidosis in a Patient with Type 2 Diabetes Mellitus

Abhinav Tiwari, MD; Hussain Al-Robeh, MD; Himani Sharma, MD; Zaid Ammari, MD; Mohammad Saud Khan, MD; Juan Carlos Jaume, MD

AACE Clinical Case Reports (Mar 2018)

Steroid-Induced Diabetic Ketoacidosis in a Patient with Type 2 Diabetes Mellitus

Abhinav Tiwari, MD,
Hussain Al-Robeh, MD,
Himani Sharma, MD,
Zaid Ammari, MD,
Mohammad Saud Khan, MD,
Juan Carlos Jaume, MD

Affiliations

Abhinav Tiwari, MD: From the Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio; Address correspondence to Dr. Abhinav Tiwari, University of Toledo Medical Center, 3000 Arlington Avenue, MS 1150, Toledo, OH 43614.
Hussain Al-Robeh, MD: From the Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
Himani Sharma, MD: From the Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
Zaid Ammari, MD: From the Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
Mohammad Saud Khan, MD: From the Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
Juan Carlos Jaume, MD: Department of Endocrinology, University of Toledo Medical Center, Toledo, Ohio.

Journal volume & issue: Vol. 4, no. 2
pp. 131 – 133

Abstract

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ABSTRACT: Objective: Diabetic ketoacidosis (DKA) is usually associated with type 1 diabetes mellitus; however, it is increasingly being recognized in patients with type 2 diabetes mellitus (T2DM). Triggering factors usually involve infections and poor medication adherence. Other potential triggers are myocardial infarction, antipsychotic drug usage, malignancy, and cerebrovascular accidents. No case of steroid-induced DKA in a patient with T2DM has been reported in the literature.Methods: Clinical and laboratory data are presented.Results: We present a case of a middle-aged patient with a history of well-controlled T2DM via metformin. The patient was started on oral prednisone for lumbar disc herniation, and then presented with acute DKA. No other trigger for DKA but steroid initiation was found.Conclusion: We conclude that patients with diabetes who receive glucocorticoids should be monitored carefully, as steroids can precipitate DKA. This may occur in the absence of any other triggering factor, and even in patients with well-controlled T2DM.Abbreviations: DKA diabetic ketoacidosis T2DM type 2 diabetes mellitus

Published in AACE Clinical Case Reports

ISSN: 2376-0605 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the endocrine glands. Clinical endocrinology
Website: https://www.journals.elsevier.com/aace-clinical-case-reports

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