SAT-570 Hemorrhagic Stroke in DKA: A Rare Presentation

Abstract Disclosure: A. Yousef: None. S. Gill: None. H. Osman: None. C. Xue: None. A. Shehadah: None. R. Vengilote: None. M. Quartuccio: None. Neurological complications of diabetic ketoacidosis (DKA) are less common in adults than in children, with cerebral edema being the most feared consequence. This report describes an uncommon neurological manifestation of DKA. A 32-year-old obese male, previously healthy, presented with sudden onset left leg weakness noted upon waking, accompanied by difficulty ambulating. He denied prior similar episodes. On examination, the patient was mildly confused, and neurological evaluation revealed decreased motor strength in the left lower extremity, with normal coordination and cerebellar function. Laboratory findings were significant for corrected sodium 143 mmol/L (normal 136-145 mmol/L), potassium 5.2 mmol/L (normal 3.5-5 mmol/L), bicarbonate 19 mEq/L (normal 23-28 mEq/L), venous pH 7.3 (normal 7.32 - 7.43), anion gap 25 mmol/L (normal 7-13 mmol/L), blood glucose 1084 mg/dL (normal 65-100 mg/dL), beta-hydroxybutyrate 6.53 mmol/L (normal <0.4 mmol/L), and hemoglobin A1c >15.5% (normal <5.6%). Urinalysis showed ketonuria and glucosuria, and a drug screen was negative. The patient denied recent alcohol or illicit drug use. Imaging, including a CT head, identified a 1.1 cm hyperattenuating lesion in the left parietal lobe, suggestive of intraparenchymal hemorrhage without midline shift. MRI of the brain confirmed the presence of a 1.2 cm hemorrhagic focus in the left parietal lobe, consistent with a cavernoma and possible recent hemorrhage. The patient was started on intravenous insulin per the DKA protocol and transitioned to subcutaneous insulin once DKA resolved. Further testing revealed a low C-peptide level of 0.7 ng/mL (normal 0.8-3.1 ng/mL) and elevated glutamic acid decarboxylase antibodies, consistent with autoimmune diabetes. During the hospital course, his lower extremity strength gradually improved as his blood glucose levels were better controlled. He was subsequently cleared for discharge with insulin therapy and scheduled for close follow-up at the Endocrinology clinic. This case highlights the rare occurrence of hemorrhagic stroke as a complication of DKA in adults. DKA is a pro-inflammatory state that induces vascular injury and hypercoagulability, increasing the risk of cerebrovascular events. While this association has been reported in pediatric populations, this case emphasizes the importance of recognizing such complications in adults and underscores the need for vigilance in managing severe DKA cases. This is the first known reported case in an adult. Presentation: Saturday, July 12, 2025