Kidney Replacement Therapy as a Rescue Strategy for Severe Acidosis in Diabetic Ketoacidosis: A Case Report.
Vahideh Sadra, Masoud Nazemiyeh, Negin Frounchi et al.
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Case in brief
A 43-year-old woman with poorly controlled type 2 diabetes presented with diabetic ketoacidosis and severe metabolic acidosis. Initial treatment was insufficient, leading to the need for hemodialysis to correct her acidosis and potassium levels. Following hemodialysis and intensive care management, her condition improved, and she was discharged on an insulin regimen.
What made this case unusual
The case highlighted refractory hypokalemia, an atypical finding in diabetic ketoacidosis, likely due to prolonged gastrointestinal losses from vomiting.
Diagnostic / clinical pearl
Clinicians should be vigilant for unusual electrolyte imbalances, such as hypokalemia, in patients with diabetic ketoacidosis, as they may indicate underlying complications.
Why it matters
This case underscores the importance of timely insulin administration in diabetic ketoacidosis management to prevent severe complications and the potential role of renal replacement therapy in refractory cases.