Endocrine Abstracts

JOINT11

Introduction: Diabetic ketoacidosis (DKA) is a serious complication of diabetes that can occur in type 2 diabetes mellitus, particularly with poor glycemic control and concurrent illnesses. This report details the presentation, management, and clinical outcomes of a patient admitted with DKA.

Case Presentation: A 62-year-old female with a history of type 2 diabetes managed with metformin, complicated by poor adherence, presented with gastrointestinal symptoms of nausea and vomiting. Her condition worsened, prompting an emergency visit where severe hyperglycemia (capillary blood glucose of 5 g/l), significant ketonuria (2+ acetone), and a raised anion gap (RA at 15) were identified, confirming DKA. On admission, she exhibited general weakness, abdominal tenderness, and an altered general condition. Laboratory findings included a white blood cell count of 10,600, elevated C-reactive protein (CRP) initially at 214 mg/l (decreasing to 66 mg/l), and negative infectious screenings (thoracic radiography and renal ultrasound). A thoraco-abdominopelvic CT scan revealed a perforated mucocele complicated by pseudomyxoma peritonei.

Discussion: Patients with mucinous neoplasms of the appendix present a clinically challenging spectrum of pathologic processes. Incidental discovery of an appendiceal mucocele is common. Pseudomyxoma peritonei (PMP), although more severe, frequently has a slow-growing course with non-specific symptoms, requiring high suspicion, especially with probable previous appendiceal pathology. Mucinous neoplasms of the appendix range from benign mucoceles to malignant cystadenocarcinomas. Accurate diagnosis and management are crucial, particularly in specialist centers focusing on preventing locoregional recurrence.

Conclusions: This case underscores the importance of recognizing and promptly treating DKA in type 2 diabetic patients, especially with poor glycemic control and additional conditions. Comprehensive management addressing underlying causes and complications is essential for optimal outcomes. Regular follow-up with thorough assessments is crucial for preventing recurrence and managing long-term complications.