18 May 2020 : Case report
Steroid-Induced Diabetes Ketoacidosis in an Immune Thrombocytopenia Patient: A Case Report and Literature Review
Unusual clinical course, Unusual or unexpected effect of treatment, Adverse events of drug therapyZiyad Alakkas1ABDEF*, Ohud A. Alzaedi2DEFG, Suresh Shivapp Somannavar2AEF, Abdulaziz Alfaifi1ADG
Am J Case Rep 2020; 21:e923372
BACKGROUND: Steroids are used as anti-inflammatory agents, administered for a variety of medical conditions, either as short- or long-term treatment. Steroid use is associated with many adverse effects, including hyperglycemia, but ketoacidosis is rare.
CASE REPORT: We present the case of a 53-year-old woman who developed diabetic ketoacidosis after administration of methylprednisolone during treatment of immune thrombocytopenic purpura. She did not have diabetes or a family history of diabetes. Steroid-induced hyperglycemia with insulin resistance, lipolysis, and ketogenesis occurred and were likely to have precipitated the ketoacidosis. Blood glucose, blood gases, and urine test results were diagnostic for ketoacidosis.
CONCLUSIONS: The risk of ketoacidosis and hyperglycemia should be considered in the course of steroid therapy, even without a diagnosis of diabetes, especially in patients who have risk factors for diabetes mellitus including obesity and long-term use of steroids, so that early identification of diabetic ketoacidosis can prevent further morbidity and mortality in chronic patients.
Keywords: Diabetic Ketoacidosis, Glucocorticoids, Hyperglycemia, Purpura, Thrombocytopenic, Idiopathic, Steroids, Anti-Inflammatory Agents, Diabetes Mellitus, Type 2, Methylprednisolone, Middle Aged, Risk Factors
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