MON-645 Metabolic Chorea: A Case Report

Abstract Disclosure: M. Vasquez Cayoja: None. R. Pujala Melero: None. J. Garnica Zenteno: None. J. Zubieta Caceres: None. Metabolic Chorea: A Case Report Introduction Hyperglycemic chorea is a rare complication in diabetic patients, associated with non-ketotic hyperglycemia, and is characterized by involuntary movements such as hemichorea or hemiballismus. It is usually accompanied by basal ganglia alterations on neuroimaging. We present the case of a 59-year-old female patient with type 2 diabetes under follow-up for 20 years and a history of hypertension, who experienced renal function deterioration leading to the modification of her treatment with NPH insulin and empagliflozin. Case Report: In November 2024, the patient presented with a two-day history of holocranial headache of mild to moderate intensity, accompanied by asthenia, adynamia, and blurred vision. Over the last 12 hours, she developed irregular, brief, bilateral involuntary movements in the upper and lower limbs and trunk, along with gait instability, prompting her admission to the emergency department. Physical examination: The patient was alert and oriented to person, place, and time, with no signs of meningeal irritation. She exhibited bilateral choreiform movements triggered by motor stimulation. Laboratory on admission: • Glucose: 339 mg/dL • Hematocrit: 30% | Hemoglobin: 10 g/dL | WBC: 8,300/mm³ (76% neutrophils) • Creatinine: 4.6 mg/dL | Urea: 160 mg/dL | ASTO Negative | Na: 135 mEq/L | K: 6.5 mEq/L | Cai 1.07 • Arterial blood gas: pH 7.26 | pO₂ 31.2 mmHg | pCO₂ 31.5 mmHg | HCO₃ 15.3 mEq/L | BE -24 A brain CT scan showed no significant findings. The patient was admitted to internal medicine and treated with a basal-bolus insulin regimen plus haloperidol 2.5 mg TID, showing a progressive and marked improvement. She was discharged without involuntary movements. In January 2025, the patient was readmitted to the emergency department with a similar presentation, associated with discontinuation of haloperidol and glucose 275 mg/dL. Complementary studies confirmed recurrent non-ketotic hyperglycemia. She was hospitalized in internal medicine, achieving rapid recovery with the reintroduction of haloperidol and metabolic control. Conclusion: Diabetic chorea is a rare complication associated with hyperglycemia. Its recurrence, as in this case, is frequent and related to episodes of metabolic decompensation. Although its pathophysiology is not fully understood, patients respond favorably to glycemic control and treatment with haloperidol. Presentation: Monday, July 14, 2025