Articles, Issue 2/2022

Diabetic Ketoacidosis as a Part of the Differential Diagnosis of Respiratory Failure

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L. Bozadjieva, A. Vladimirow, D. Iliev


Abstract

Diabetic ketoacidosis is an acute complication of type 1 diabetes mellitus that can have a fatal outcome if it is not recognized on time. The reported frequency of diabetic ketoacidosis as the first presentation of childhood diabetes mellitus ranges from 15% to 67% in various studies. Kussmaul breathing, characterized by tachypnea and increased depth of breath, is a classic sign of ketoacidosis. We present four clinical cases of diabetic ketoacidosis in which hyperpnoea is wrongly interpreted as a sign of a respiratory tract infection. The prescribed antibiotics and symptomatic therapy have no effect and cause the long persistence of the katabolic processes ensuing in diabetic ketoacidosis. Important questions probing for polyuria and polydipsia should be asked in young children presenting with respiratory issues to help identify whether diabetic ketoacidosis is a diagnostic consideration. We recommend performing point-of-care capillary blood glucose testing or ketones in children presenting with symptoms of respiratory distress and reduced level of consciousness to assess for diabetic ketoacidosis. The earlier recognition of diabetes mellitus type 1 or diabetic ketoacidosis before hospitalization, the less critically ill patient would be admitted at the intensive care unit.

Keywords: diabetic ketoacidosis, type 1 diabetes mellitus, Kussmaul breathing, brain edema, ketones, and hyperglycemia

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Address for correspondence:

Clinic of Endocrinology, Diabetes and Genetics,
Department of Diabetes, SBALDB “Prof. Ivan Mitev”, Sofia
11, “Аcad. Ivan Geshov”, Str.
1606, Sofia, Bulgaria
е-mail: bozadzhieva.l@gmail.com