Diabetic Ketoacidosis Revealing Severe Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD-D) Deficiency with Methemoglobinemia: A Case Report
Unusual clinical course, Challenging differential diagnosis, Management of emergency care
Alaa A. Alzaki, Noor H. Alalawi
(Department of Internal Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia)
Am J Case Rep 2019; 20:726-729
Glucose-6-phosphate dehydrogenase deficiency (G6PD-D) is the most common red blood cell enzymopathy disorder. Severe hemolysis due to G6PD-D may rarely manifest as methemoglobinemia. Although acute hemolytic crises are usually induced by the exposure to certain oxidative stresses, diabetic ketoacidosis may also elicit hemolytic reactions in G6PD deficient persons.
CASE REPORT: A 17-year-old male with type 1 diabetes mellitus presented with diabetic ketoacidosis and features of hemolytic anemia which turned to be G6PD-D related. Interestingly, the arterial blood gas of the patient showed an elevated methemoglobin level (8.1%).
CONCLUSIONS: G6PD-D induced hemolysis is conventionally caused by oxidative stress, however, we report here a case of G6PD-D induced methemoglobinemia as a complication of diabetic ketoacidosis that has not been, as far as we know, previously reported.
Keywords: Diabetic Ketoacidosis, Glucosephosphate Dehydrogenase Deficiency, Hemolysis, methemoglobinemia