Diabetic ketoacidosis complicated by generalized venous thrombosis

Abstract

Venous thromboembolism is a rarely described complication of diabetic ketoacidosis (DKA). We describe a 21-year-old male patient with poorly controlled type 1 diabetes mellitus who was admitted with DKA, presumably secondary to noncompliance, whose clinical picture was complicated by generalized thrombosis involving multiple venous locations including renal vein, pulmonary vasculature, external iliac and common iliac veins. The patient had no family history of any coagulation disorders and a hypercoagulabilty work-up remained negative. The patient was subsequently anticoagulated with heparin and discharged home on warfarin. To the best of our knowledge, this is the first reported case of multiple venous thromboses occurring as a complication of DKA with no other risk factors. We also reiterate that although rare, venous thrombosis should always be considered as a potential complication of DKA.

Fatal Pulmonary Thromboembolism in Patients with Diabetic Ketoacidosis: A Seven-Case Series and Review of the Literature

“…More recently, Ozdemir et al reported a case of a 57-year-old woman who was admitted with DKA and a pulmonary embolus, successfully treated with tissue plasminogen activator and found to have elevated homocysteine concentrations (46). Cherian et al reported a case of a 21-year-old man with type 1 diabetes mellitus that developed multiple venous thromboses, including the renal vein, iliac veins and pulmonary vasculature, three days after admission for diabetic ketoacidosis due to non compliance with insulin therapy (31). A similar case of portal vein thrombosis in a patient with DKA was recently seen in our office.…”

“…Platelet function has been shown to be abnormal in DM (29). Several reports have suggested that diabetes mellitus, and diabetic ketoacidosis in particular, represent a prothrombotic state (25,(30)(31)(32). Carl et al monitored the changes of protein C, protein S, von Willebrand factor (vWF), fibrinogen, homocysteine and folate in a group of young patients with DKA prior to, during, and following treatment (30).…”

“…'Hypercoaguability work-up was negative.' 12 Forensic pathologists described seven cases of fatal massive pulmonary embolus in DKA. In four patients the diagnosis was made post-mortem.…”

Veins, venous thromboembolism, and diabetes

“…He developed multiple venous thromboses including renal, pulmonary, and iliac veins. ‘Hypercoaguability work‐up was negative.’ Forensic pathologists described seven cases of fatal massive pulmonary embolus in DKA. In four patients the diagnosis was made post‐mortem …”

Central Pontine Myelinolysis in Pediatric Diabetic Ketoacidosis

“…Hematology workup showed no underlying hypercoagulability. Thus the DVT was considered as another complication of DKA [ 20 – 22 ].…”