Challenges in severe diabetic ketoacidosis: case report and literature review

Diabetic ketoacidosis (DKA) is a serious acute complication of diabetes mellitus (DM), especially type 1 diabetes mellitus (DM1), which can occur as the first manifestation of the disease.Diagnosis requires blood glucose above 250mg/dL, metabolic acidosis with serum bicarbonate <18mEq/L and/ or blood pH < 7.4, as well as ketone bodies in the blood or urine.The main etiologies are infections and poor adherence to insulin treatment.In management, it is essential to check serum potassium levels before insulin therapy.Serum bicarbonate replacement can also be useful, although this is controversial in the literature.The case in question refers to a patient who sought emergency care for dyspnea, fatigue and abdominal pain, evolving with worsening general condition, due to a cutaneous lumbar abscess.The rarity of the condition is due to a serum bicarbonate level of less than 1 mmol/L, with few reports found in the medical literature, as it is mostly incompatible with life.