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January 14, 2001

Hyperglycemia and DKA

Question from Gainesville, Florida, USA:

How can diabetic ketoacidosis, if left untreated, lead to gangrenous bowels?

Answer:

Among the signs and symptoms of DKA [diabetic ketoacidosis], the abdominal signs (pain, nausea, gastric distension, vomiting and anorexia) are frequently a predominant feature, sometimes mimicking an acute abdominal condition (called an “acute abdomen”), raising the issue of whether the DKA has been precipitated by a primary intraabdominal disorder. The abdominal pain is a particularly worrisome complaint since it is often accompanied by voluntary guarding and generalized tenderness and elevation of some serum enzymes (amylase, transaminase) that do not always have diagnostic specificity of an abdominal disorder and often are misleading.

Care must be exercised to determine whether such changes are indicative of a significant coexistent disease (and then not to overlook a surgical abdomen) or only incidental as often happens. The mechanism of the acute abdominal pain that is often present in patients with DKA is still unknown: diabetic neuropathy and/or electrolyte deficiencies might play a major role.

MS