Diabetic ketoacidosis [DKA] is known to be precipitated by number of clinical situations which lead to increased production of counter regulatory hormones Substance abuse has recently been highlighted as a risk factor in DKA. Cocaine has not received sufficient emphasis. We report a case of multiple admissions for DKA associated with cocaine use.
A 23 year old male student was brought to emergency room for altered sensorium of ten hours duration. He was a known patient of Type 1 diabetes mellitus of 8 years duration. He was on short acting plain human insulin twenty eight units per day in 3 meal related doses and intermediate acting human insulin twelve units at 10 PM. He had stopped taking insulin for six hours prior to hospitalisation.
Clinical examination revealed a male with a body mass index of 21 . He was comatose with minimal response to deep painful stimuli. His breathing was acidotic and severe dehydration was noticed with a blood pressure of 80/60 millimeters of mercury in supine position. Pulse rate was 110 per minute . He had microvascular complications of diabetes. Investigations- plasma glucose 456 milligram per deciliter, pH 7.18, serum bicarbonate 12 milliequivalent per litre, urine ketones 3+, serum ketones positive 1:2 dilution, serum potassium 5.0 milliequivalent per liter, blood urea nitrogen 19 milligram per deciliter, c-peptide 0.21 nanomol, fattyacids 1.6 nanomol. A diagnosis of DKA was made. He was treated with plain insulin drip, normal saline and other supportive measures. He made rapid clinical and biochemical recovery over next fourteen hours.
This was his third admission in the preceding nine months for DKA. On close questioning he revealed that he was using cocaine[crack] for last 3 years. Last binge was sixteen hours before hospitalisation. Urine drug screen revealed cocaine metabolites.
22 - 24 Mar 2004
British Endocrine Societies