Life threatening abdominal compartment syndrome as an early complication of new onset ketosis prone type 2 diabetes mellitus

 

Background:

During the past decade, the diagnosis of diabetic ketoacidosis has been increasingly recognized. Most adults with ketosis prone type 2 diabetes are obese, middle-aged persons with newly diagnosed diabetes who present with unprovoked diabetic ketoacidosis. Successful clinical management of diabetic ketoacidosis requires aggressive fluid replacement and administration of insulin. Acidosis and aggressive fluid replacement are risk factors for the development of intra-abdominal hypertension (IAH), ultimately manifested as the abdominal compartment syndrome (ACS) if overt organ failure ensues. Overt ACS is associated with a mortality approaching 100% without treatment in some reports.

Case report:

We report a case of a 53 year old women with new onset ketosis prone type 2 diabetes mellitus presenting with severe ketoacidosis. She developed secondary abdominal compartment syndrome as an early complication of acidosis and high volume fluid replacement which was treated successfully with decompressive laparotomy.

Discussion:

In our patient, fluids were initially administered at high volume because of hypotension and volume depletion. Together with metabolic acidosis induced by diabetic ketoacidosis the deleterious cascade of IAH and ACS developed. Fortunately, by abdominal decompression the vicious circle could be stopped and the patient recovered completely.

This report provides a cautious warning by noting that ACS can occur as a consequence of diabetic ketoacidosis. Measurement of intraabdominal pressure should be started if aggressive fluid replacement is required. Prompt appropriate actions to decrease intraabdominal pressure must be initiated to save the life of patients confronted with this rare complication of new onset diabetes.