Uncontrolled diabetic ketoacidosis can lead to brain stem infarct and death; a case report

Diabetic ketoacidosis (DKA) is a triad of hyperglycemia, metabolic acidosis and ketosis. It is a life-threatening complication of diabetes mellitus (DM) that can lead to death without appropriate treatment. DKA with stroke increases morbidity and mortality in the intensive care unit (ICU). A 37-year-old male was brought to the emergency department with sudden onset of weakness for the past two days. He had been diagnosed with type 2 DM five years earlier, but it was poorly controlled. On examination, his Glasgow Coma Scale was within normal limits. Laboratory and radiological investigations revealed severe hyperglycemia, metabolic acidosis, and brain stem infarct. He required intubation and was admitted to the ICU with a diagnosis of DKA and cerebellar and brain stem infarct. The patient succumbed to death despite 13 days of ICU management. DKA can precipitate a cerebellar and brain stem infarct, but it can be fatal despite extreme management in the ICU. Abbreviations: DKA - Diabetic ketoacidosis; DM - Diabetes mellitus; ICU - Intensive care unit; CED - Cerebral edema; ED - Emergency department Key words: Diabetic ketoacidosis; Stroke; Brain stem infarct; Cerebral edema; Mortality Citation: Zukhi NJM, Mazlan MZ, Suhaimi FM. Uncontrolled diabetic ketoacidosis can lead to brain stem infarct and death; a case report. Anaesth. pain intensive care 2022;26(2):253-256; DOI: 10.35975/apic.v26i2.1808 Received: December 24, 2021; Reviewed: February 07, 2022; Accepted: February 07, 2022