A 30-year-old woman with a history of hypothyroidism and DM1 since she was 8 years old.
In his last follow-up three months before, his glycosylated hemoglobin (HbA1c) was 8.5%.
She presented with vomiting on seven occasions and abdominal pain without diarrhea or fever.
Because she was not eating adequate amounts of food, she missed the insulin dose on the same day as the appointment.
Directly, the patient does not report prolonged fasting, alcohol intake or risk of pregnancy prior to the onset of symptoms.
On admission, the patient was alert, and the examination showed signs of mild extra cellular volume deficit (ECV).
Her body mass index was 29 Kg/m2.
Laboratory tests at admission showed leukocytosis of 26,000 x mm3, blood glucose 200 mg/dl, arterial gases with severe metabolic acidosis (pH 7,1 and bicarbonate of 7 meq+L), ketonemia + urine.
C-reactive protein, renal function, amylasemia and plasma electrolytes were within normal limits.A CT scan of the abdomen and pelvis showed no abnormalities.
He was admitted to the Intensive Care Unit (ICU), starting parenteral hydration and intravenous crystalline insulin in continuous infusion.
And favorable.
Given the presence of two diabetic ketoacidosis (DKA) without a clear precipitating factor and urinary incontinence prior to discharge, the patient reported having experienced hyperglycemia, then she was reinterrupted about using other medications.
Once removed, insulin scheme was adjusted and discharged on the fourth day of hospitalization.
A notification was made to the Public Health Institute and the Janssen Chile Laboratory was informed, constituting the first reported case of DKA with the use of these drugs in our country.
