MON-630 Cycle of Crisis: A Case of Catamenial DKA

Abstract Disclosure: E. Rosario Diaz: None. K. Kim: None. T. Porter: None. Background: Catamenial syndrome describes a group of conditions with a temporal relationship to the menstrual cycle as a result from hormonal fluctuations in estrogen and progesterone. While the condition is infrequent, it is typically associated with pulmonary, dermatologic, or neurologic symptoms. To date, less than 10 cases of catamenial diabetic ketoacidosis (DKA) have been reported in the literature. Body: A 40-year-old female without medical history presented to the emergency department after a fall with loss of consciousness, headaches, poor oral intake, increased thirst and nausea. Physical exam was remarkable for dry mucous membranes, delayed capillary refill and tachycardia. Laboratories remarkable for leukocytes 14.63 K/uL (4.00 - 10.00 K/uL), glucose 344 mg/dL (74 - 100 mg/dL), potassium 5.8 mmol/L (3.4 - 5.3 mmol/L), bicarbonate 9 mmol/L (​​22 - 29 mmol/L), corrected anion gap 27 (8 - 16), pH 7.28 (7.33 - 7.43), ketones 4.8 mmol/L (0 - 0.6 mmol/L), pregnancy test negative. She was diagnosed with DKA and admitted to the ICU. Initial management included intravenous insulin (3.5 U/hr) and aggressive fluid resuscitation with lactated ringer solution, later transitioned to 0.45% saline with 5% glucose as blood glucose levels trended down. The next day, laboratory results showed normalization of the leukocyte count, glucose, potassium, bicarbonate, pH, ketone level and closure of the anion gap. The patient tolerated oral intake and was transitioned to 15 units of basal insulin daily and sliding scale with rapid acting insulin. Hemoglobin A1c was 4.8% and fructosamine 207 umol/L (0 - 285 umol/L), further tests including hemoglobin electrophoresis, C-peptide, autoantibodies against glutamic acid decarboxylase, IA-2, and insulin were unremarkable. A contrast-enhanced CT scan showed no pancreatic abnormalities. Before being discharged her menstrual cycle started. She remained asymptomatic in the outpatient setting so her long-acting insulin was reduced to 6 units daily and 10 units with menses. A continuous glucose monitor was placed, and her average glucose was 113 ± 18 mg/dL so long-acting insulin was discontinued and the menstrual dose reduced to 8 units. She was saw gynecology where oral contraception was started to avoid hormonal fluctuations and decrease premenstrual symptoms. Conclusion: Catamenial DKA is a challenging diagnosis because most cases of catamenial syndrome have been associated with epilepsy and pneumothorax. This highlights the uniqueness of this case as fewer than 10 reports of DKA in this setting have been described and when present, are almost exclusively associated in those with previous history of type 1 diabetes which in this case is absent. This case underscores the complexity of hormonal influences on metabolic control and the need for clinicians to consider this etiology in women with and without diabetes who experience cyclical metabolic derangements. Presentation: Monday, July 14, 2025