Poster (C11)- #STPE55 - KEYWORDS: Catamenial DKA

Catamenial DKA

Vasquez Espinosa, William MD; Yegneswaran, Balaji MD.
aint Peter's University Hospital/Rutgers Robert Wood Johnson Medical School

ABSTRACT:
Catamenial Diabetic Ketoacidosis: Case report William Vasquez Espinosa, MD1, Balaji Yegneswaran, MD2 Background Diabetic Ketoacidosis (DKA) is a well know complication in patients with Diabetes Mellitus. It is caused by an imbalance of glucagon/insulin ratio which results in ketone prone state in the body due to gluconeogenesis, glycogenolysis and lipolysis that rapidly develops into acidosis. Here we present a case where the patient has DKA due to her menstrual cycle. Case presentation A 29-year-old African American female with Type 1 diabetes mellitus diagnosed at age 16, who is on a basal and premeal insulin at home is noted to have four recurrent admission to the hospital with a diagnosis of DKA. The last 3 admissions happened in consecutive months almost on the same day. On the emergency department she usually presented with nausea, vomiting and abdominal pain. Her blood glucose levels during her admissions ranged from 246 to 400, her bicarbonate 11-20, pH between 7.22 -7.33, anion gap 15-23 with blood ketones; exams consistent with diagnosis of DKA. No clear precipitant factor was found on any hospital visit as she said being complaint with her insulin regimen and not having recent infection or other symptoms. Complementary exams to check for a possible precipitant which included CBC, BMP, UA, pregnancy test, chest Xray, viral panels and other imaging studies were always negative. On review of the history of the three admissions it was noted that all her admission occurred during her menstrual period. She ascertained having regular cycles and that her hospitalizations occurred on the second day of her menses. The DKA was always diagnosed and admitted she received appropriate treatment was administered in all admission. The patient needed an average of 1.7 days of ICU care and had an average LOS of 2.7 days. The patient was diagnosed with Catamenial Diabetic Ketoacidosis on the third admission and education was given to increase her dose of insulin to avoid precipitation of DKA in future. Discussion Catamenial DKA is a rare disease but patient who have it tend to use a lot of resources. It is important physicians should elicit a proper menstrual history when a patient comes with DKA and with appropriate history physicians can save a lot of resources as once diagnosed treatment is easier.