Acute respiratory distress syndrome in a case of diabetic ketoacidosis requiring ECMO support

Abstract

Summary Acute respiratory distress syndrome (ARDS) is a rare but life-threatening complication of diabetic ketoacidosis (DKA). We present the case of a young female, with no previous diagnosis of diabetes, presenting in DKA complicated by ARDS requiring extra corporeal membrane oxygenation (ECMO) ventilator support. This case report highlights the importance of early recognition of respiratory complications of severe DKA and their appropriate management. Learning points ARDS is a very rare but life-threatening complication in DKA. The incidence of ARDS remains unknown but less frequent than cerebral oedema in DKA. The mechanism of ARDS in DKA has multifactorial aetiology, including genetic predisposition. Early recognition and consideration of rare pulmonary complication of DKA can increase survival rate and provide very satisfactory outcomes. DKA patients who present with refractory ARDS can be successfully rescued by ECMO support.

Extracorporeal membrane oxygenation in diabetic ketoacidosis-related cardiac and respiratory failure

“…[2][3][4]6 However, both the primary condition and treatment can give rise to cardiopulmonary complications, contributing to increased mortality. [7][8][9] Cardiovascular complications are often attributed to imbalances in electrolyte and acid-base levels. 8 Arrhythmias can occur due to hyperkalemia in early DKA stages or hypokalemia following fluid and insulin therapy.…”

“…11 Additionally, myocardial depression, injury/necrosis, infarction, and stress cardiomyopathy have been reported with DKA, although the exact mechanisms remain unclear. 3,7,8,10,[12][13][14][15][16][17] Respiratory failure in patients with DKA is a complex phenomenon with multiple contributing factors. 7,9 Excessive fluid resuscitation can cause pulmonary edema without left ventricular systolic failure.…”

“…3,7,8,10,[12][13][14][15][16][17] Respiratory failure in patients with DKA is a complex phenomenon with multiple contributing factors. 7,9 Excessive fluid resuscitation can cause pulmonary edema without left ventricular systolic failure. 7,18 Acidosis can increase alveolar capillary membrane permeability and metabolic abnormalities can trigger cytokine release and pulmonary infiltrates, both leading to acute respiratory distress syndrome.…”

“…We conducted a literature review to identify existing studies on ECMO use in patients with DKA. Our search yielded nine relevant publications, including eight single case reports, 7,[12][13][14][19][20][21][22] and one case series involving 12 patients with endocrine emergencies supported with ECMO, 3 of whom had DKA. 23 Venovenous ECMO in DKA.…”

“…The patient survived and was discharged on hospital day 16. 7 Another case involved a 44-year-old with type 1 DM who experienced DKA-related cardiac arrest and subsequent respiratory failure caused by aspiration pneumonia. ECMO duration was not reported, but the patient survived to discharge.…”