READING TIME: 2.5 MINUTES
28 year old women known to suffer from “Cyclical Vomiting” presented to ED as she felt poorly. Vomiting a dozen times daily was a routine but today was something different. She had thrown up >20 times in a day.
Her initial observations were
Pulse 127/min BP 95/59 SpO2 93% on air
Abdomen was tender in epigastrium with no guarding. She appeared severely dehydrated.
Initial blood gas showed
Base excess -11
Glucose 7.8 mmol
Urea 8.1 mmol/L
No obvious cause of shock was recognised. Pt was resuscitated with IV fluids and was given broad spectrum anti-biotics.
Significant lab results were
Urea 8.9 mmol/L Creatinine 136 umol/L GFR 39 INR 1.2
After 3.5 litres of fluids, repeat ABG showed
pH 7.14 HCO3 13 Base excess -10 Glucose 14 mmol Lactate 11.5
So glucose was rising, acidosis was worsening & lactate was creeping up. ketones were tested which were high (6.6).At this point, patient was started on DKA protocol as she met the criteria(hyperglycemia, ketonemia and acidosis).
But this wasn’t a simple DKA. Patient was in multi organ failure with high lactate and refractory acidosis. CT abdomen was arranged and ITU were involved.
Fig 1 Large amount of free air can be seen in the pancreas
This was a case of necrotizing pancreatitis associated with DKA and multi organ failure as a complication.She was taken to ITU where she made a gradual but full recovery.