
January 17, 2007
Aches and Pains, Diagnosis and Symptoms
Question from Oregon, USA:
My daughter was recently diagnosed with type 1 diabetes after being admitted to the hospital in diabetic ketoacidosis. She had an arterial blood gas with a pH of 6.83, large ketones, high blood sugar, very low potassium, fast heart rate in the 140 to 160s, etc. She ultimately needed to be intubated to blow off the excess carbon dioxide and for fear of respiratory arrest. There was also a concern of cerebral edema as she presented with an excruciating headache, confusion, hypertension, and she became very combative. She was life-flighted to a larger hospital that had a pediatric intensive care unit and pediatric endocrinologists. The day she was discharged from the hospital, she complained that her right calf was really sore. We reported this to the nurse who seemed unconcerned and shrugged her shoulders. When we returned home, we talked to our family practitioner who set her up for a vascular ultrasound. A blood clot was found in her calf and she has now been started on Lovenox and Coumadin. What could have caused the blood clot? Are people with type 1 diabetes more susceptible to blood clots? Are people with type 2 diabetes more or less susceptible to clots?
Answer:
All the very high numbers caused the blood to “sludge” in her leg, causing the clot. This is very rare. I would ask for special tests to see if she is at risk to clot. She may need a consultation with a pediatric hematologist. I have seen this before, but only in cases with other risks to clot. Be sure to ask for special tests.
LD