Endocrine Abstracts

Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening metabolic complication of diabetes that requires prompt recognition and treatment to improve outcomes. Common precipitating factors include infection, intercurrent illness, medication non-adherence, and failure of insulin delivery systems. Typical clinical features often include gastrointestinal symptoms such as nausea, vomiting, and abdominal pain; however, hiccups are an unusual and rarely reported manifestation. Diagnosis is confirmed through biochemical evaluation, and timely intervention is lifesaving. We report the case of a 65-year-old male with a history of type 2 diabetes mellitus, diagnosed four years earlier after an episode of DKA, and atrial fibrillation, who presented with persistent, intractable hiccups. His medications included dapagliflozin, metformin, bisoprolol, atorvastatin, amlodipine, and rivaroxaban. On presentation, arterial blood gas demonstrated a pH of 7.217. Laboratory studies revealed hyperglycaemia (23.4 mmol/l) and ketonemia (6.1 mmol/l), confirming DKA, with a HbA1c of 123 mmol/mol. Insulin was 37 mU/l and c-peptide 0.93 µg/l. Autoimmune markers were negative. CT brain revealed a probable left frontal meningioma or granuloma and bilateral low-attenuation areas posterior to the lateral ventricles; he declined further investigation with an MRI. Management followed the institution’s DKA protocol. Dapagliflozin was discontinued, and a basal–bolus insulin regimen was initiated. It remains unclear whether the hiccups and reduced oral intake precipitated DKA or represented an atypical presenting feature. This case highlights the need for clinicians to recognize unusual presentations of DKA, particularly in patients with type 2 diabetes, to ensure timely diagnosis and management.