SUN-817 Multifactorial Diabetic Ketoacidosis in an Older Patient With Myasthenia Gravis Exacerbation: A Case for Enhanced Endocrinology Education and Co-management Strategies

Abstract Disclosure: E.L. Marrero-Torres: None. J. Casal-Hidalgo: None. Diabetic Ketoacidosis (DKA) is a serious complication of diabetes that can be precipitated by multiple factors, including infections and steroid therapy. This case underscores the complexities of managing DKA in patients with multiple comorbidities, particularly in the context of Myasthenia Gravis (MG) exacerbation and highlights the importance of educating endocrinologists about integrated care for such high-risk patients. We present the case of an 81-year-old male with a medical history of Diabetes Mellitus Type 2, Myasthenia Gravis (MG), Hypertension, and Oropharyngeal dysphagia, who was admitted to our institution ICU for Diabetic Ketoacidosis (DKA), suspected to be secondary to either an infectious process or steroid-induced etiology. The patient had recently been discharged after a MG exacerbation, for which he was discharge with prednisone 25 mg daily. Upon readmission, he exhibited symptoms of lethargy and hypoactivity. Laboratory results revealed a significant hyperglycemic episode, anion gap metabolic acidosis with pH<7.3, and an elevated beta-hydroxybutyrate level at (83.3). The patient was diagnosed with multifactorial DKA, likely induced by recent steroid therapy and a Pseudomonas aeruginosa bacteremia, for which he received appropriate antibiotics. The patient’s management included insulin infusion, IV fluids, and a gradual transition to subcutaneous insulin after 24 hours. However, as his prednisone tapering proceeded to aid in further glucose control, signs of MG exacerbation (e.g., generalized weakness, bilateral ptosis) emerged, requiring careful adjustment of both his insulin regimen and prednisone dose. This case illustrates the challenges of managing DKA in patients with multiple comorbidities, especially when steroids are involved in the treatment of conditions like Myasthenia Gravis. The importance of comprehensive patient education and coordinated care is highlighted, particularly in the context of steroid use and its impact on glycemic control. Previous admissions revealed episodes of hyperglycemia likely due to steroid therapy, which could have been mitigated with better follow-up care and closer monitoring. Endocrinologists must be equipped with a broad understanding of managing DKA in the context of complex comorbid conditions such as Myasthenia Gravis. This case underscores the critical role of interdisciplinary care and the need for tailored educational interventions aimed at improving patient outcomes, reducing readmissions, and preventing complications such as DKA. Enhanced training in managing multifactorial DKA, especially in older patients with complex medical histories, is crucial for optimizing care in endocrinology practice. Presentation: Sunday, July 13, 2025