Alcohol Induced Diabetic Ketoacidosis Exacerbated by an Acute Respiratory Infection with Klebsiella pneumoniae

Abstract

Ketoacidosis is a metabolic condition that occurs as a result of an insufficient amount of insulin. The lack of insulin results in an increased release of glucose from the liver and an excess of ketone bodies as a result of the breakdown of adipose tissue. This occurs when carbohydrates are unable to be properly processed for needed energy requirements during cellular metabolism. Ketoacidosis is commonly linked to diabetes mellitus. Diabetes mellitus is a condition where the body is unable to produce the proper amount of insulin or is unable to effectively respond to insulin stimulation. Excessive alcohol use can damage the pancreas, reducing insulin secretion. Other conditions such as pneumonia or urinary tract infections can trigger the release of counter-regulatory hormones that may contribute to the decrease in insulin's activity and secretion. Symptoms of diabetic ketoacidosis often include nausea and vomiting, increased thirst and urine production, hyperglycemia, abdominal pain, shortness of breath, confusion, headache, general weakness, fatigue and increased heart rate. If left untreated, diabetic ketoacidosis can lead to more serious complications including circulatory collapse, decreased blood potassium levels, infection and cerebral edema. The following case study presents a complex condition of ketoacidosis associated with a bacterial infection compounded by the patient's history of alcohol abuse.

ABBREVIATIONS: CBC - complete blood count, CMP - complete metabolic panel, IV - intravenous fluid, mg/dL-milligrams per deciliter, mmol/L - millimoles per liter, mM - milli molar, IU/L - international unit per liter, g/dL - grams per deciliter, mmHg - millimeters of mercury, pCO₂ - partial pressure of carbon dioxide, CT - computed tomography, ICU - intensive care unit, μg/dL - micrograms per deciliter, ng/mL - nanograms per milliliter, U/L - units per liter, mOsm/kg - milliosmoles per kilogram, μmol/L - micromole per liter, pKa - acid disassociation constant