• PDF / 170,248 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 23 Downloads / 169 Views

DOWNLOAD

REPORT

---

1 S

Fasting ketoacidosis and euglycemic diabetic ketoacidosis: case report A 71-year-old man developed fasting ketoacidosis and euglycaemic diabetic ketoacidosis during treatment with etomidate and hydrocortisone [not all routes and dosages stated; indications and durations of treatments to reaction onsets not clearly stated]. The man, whose medical history was notable for incomplete quadriplegia and long standing type 2 diabetes mellitus, was admitted for the management of chronic, non-infected pressure wounds. He developed hospital-acquired pneumonia involving symptoms of fever, shortness of breath and cough, with a new infiltrate being visible on chest X-ray. He had been receiving unspecified hypoglycaemics for his glycaemia. He subsequently developed respiratory distress with impending respiratory failure. Therefore, he was intubated with rapid sequence intubation. He started receiving etomidate and rocuronium bromide [rocuronium] with co-administration of IV hydrocortisone 50mg every 6 hours. His oral hypoglycaemics were discontinued, and an insulin sliding scale was initiated. Twelve hours post intubation, laboratory parameters were as follows: pH7.33, partial pressure of carbon dioxide (pCO2) 33.1, partial pressure of oxygen (pO2) 86.1, bicarbonate (HCO3) 20.5, anion gap 21, serum β-hydroxybutyrate >4 mmol/L and blood glucose 160 mg/dL. Therefore, hydrocortisone was stopped, and the man was treated with 5% dextrose infusion with insulin regimen, leading to a rapid closure of his anion gap with improvement in ketone levels. The fasting ketoacidosis and euglycaemic diabetic ketoacidosis were associated with the co-administration of etomidate and hydrocortisone. Alexis A. The domino(side) effect: Steroid induced ketosis post rapid sequence intubation with etomidate and hydrocortisone. American Journal of Respiratory and Critical Care Medicine 199: abstr. A1715, No. 9, May 2019. Available from: URL: https://doi.org/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A1715 803446284 [abstract]

0114-9954/20/1787-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved

Reactions 18 Jan 2020 No. 1787