Endocrine Abstracts

Diabetic ketoacidosis (DKA) can be associated with severe complications which are now rarely seen with improvements in management. We present the case of an 18- year-old male patient, who looked young for his stated age and presented comatose, in severe DKA with ketones of 6.5mmol/l, ph <7.0 and incalculable glucose and bicarbonate. Due to reduced consciousness, he required immediate intubation and despite treatment by DKA protocol showed no improvement in responsiveness. A CT brain scan revealed small volume sulcal sub-arachnoid haemorrhages (SAH) in the left temporoparietal region and the right parietal lobe. CT angiogram and venogram showed no evidence of aneurysm or sinus thrombosis. Over the subsequent 24 hours the patient required bicarbonate infusion followed by continuous veno-venous haemofiltration due to persistent acidosis with elevated lactate. A CT abdomen and pelvis showed gross (26 cm) hepatomegaly. Over the subsequent 48 hours the patient gradually improved with normalisation of his biochemistry and level of consciousness without evidence of neurological deficit. A repeat brain CT showed resolution of the SAH. This case shows illustrates rare complications of poorly controlled diabetes – probable Mauriac syndrome, given the massive hepatomegaly, and SAH associated with DKA, of which there are rare prior case reports. The pathophysiology of the SAH remains unclear but the fact that it resolved in a short space of times suggests that it was exudative in the context of severe DKA and chronic liver disease.