A case of DKA with Pulmonary Thromboembolism in a newly diagnosed young diabetic male

Chaithanya R^1*, Sharath Kumar D Shah²,  Nataraj G³

¹Final Year Post Graduate, ²Professor and Head, ³Professor, Department of General Medicine
Sri Siddhartha Medical College, SSAHE, Tumkur,
Karnataka, India

* Corresponding author

Abstract
Diabetic Ketoacidosisis [DKA] is a risk factor for developing venous thromboembolism which can be fatal if not recognised  and treated on time. We report a case of DKA with pulmonary thromboembolism in a newly diagnosed diabetic patient. A 30 year old male patient presented to our emergency department with history of generalised weakness, shortness of breath, and dry cough for 10 days. His blood sugars were high and ketone bodies were positive. CT pulmonary angiography showed irregular filling defects in right and left pulmonary arteries and multiple pulmonary infarcts. Patient was treated with insulin and low molecular weight heparin (enoxaparin). The patient condition improved in 5 days and he was discharged with oral anticoagulants (rivoroxaban) and insulin.
In view of normal B12 deficiency, normal homocysteine levels and various other normal laboratory parameters in this patient, DKA can be considered as a single risk factor for the development of pulmonary thromboembolism. This case establishes the need for further studies and discussion about prophylactic anticoagulation in DKA patients to prevent venous or pulmonary thromboembolism.
Keywords: Diabetic ketoacidosis, Pulmonary thromboembolism, Venous thromboembolism, DKA, Heparin