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Pandit K, Khanal S, Adhikari S, et al. Acute mountain sickness induced diabetic ketoacidosis managed with hemodialysis: A case report. Ann Med Surg (Lond). 2020;56:165-168doi: 10.1016/j.amsu.2020.06.012.
Pandit, K., Khanal, S., Adhikari, S., & Acharya, S. P. (2020). Acute mountain sickness induced diabetic ketoacidosis managed with hemodialysis: A case report. Annals of medicine and surgery (2012), 56165-168. https://doi.org/10.1016/j.amsu.2020.06.012
Pandit, Kamal, et al. "Acute mountain sickness induced diabetic ketoacidosis managed with hemodialysis: A case report." Annals of medicine and surgery (2012) vol. 56 (2020): 165-168. doi: https://doi.org/10.1016/j.amsu.2020.06.012
Pandit K, Khanal S, Adhikari S, Acharya SP. Acute mountain sickness induced diabetic ketoacidosis managed with hemodialysis: A case report. Ann Med Surg (Lond). 2020 Jun 13;56:165-168. doi: 10.1016/j.amsu.2020.06.012. eCollection 2020 Aug. PMID: 32637094; PMCID: PMC7330143.
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Ann Med Surg (Lond). 2020 Jun 13;56:165-168. doi: 10.1016/j.amsu.2020.06.012. eCollection 2020 Aug.

Acute mountain sickness induced diabetic ketoacidosis managed with hemodialysis: A case report.

Annals of medicine and surgery (2012)

Kamal Pandit, Sushil Khanal, Samaj Adhikari, Subhash Prasad Acharya

Affiliations

  1. Department of Critical Care, Grande International Hospital, Kathmandu, Nepal.
  2. Institute of Medicine, Maharajgunj, Kathmandu, Nepal.
  3. Professor, Department of Anaesthesiology, Institute of Medicine, Maharajgunj, Kathmandu, Nepal.

PMID: 32637094 PMCID: PMC7330143 DOI: 10.1016/j.amsu.2020.06.012

Abstract

INTRODUCTION: The risk of developing ketoacidosis in patients with type 1 diabetes at high altitude is high. Anorexia associated with acute mountain sickness, dehydration and additional exercise associated with climbing exacerbates the generation of ketones and the development of ketoacidosis.

CASE PRESENTATION: A 33-year-old gentleman with known history of uncontrolled type 1 diabetes mellitus trekked to Everest Base Camp at an altitude of 3440 m and became unwell. He developed altered sensorium and shortness of breath. He ingested eight tablets of acetazolamide (250 mg each) to address these symptoms. Upon presentation to emergency, he was diagnosed with severe diabetes ketoacidosis (DKA) with shock. Resuscitation was started with fluid, insulin, vasopressors and mechanical ventilation. Despite adequate fluid resuscitation, insulin, bicarbonates and other supportive measures, his acidosis and shock persisted and then managed with hemodialysis. After the first session of hemodialysis, improvement in acidosis and shock was noted. He was successfully extubated and later discharged.

DISCUSSION: In this case report, DKA due to acute mountain sickness was complicated by acetazolamide use and noncompliance to his regular insulin intake. There is no proper guideline regarding the role of renal replacement therapy in management of DKA. However, evidence of hemodialysis in DKA is limited to few case reports. Improvement seen in our patient after dialysis is related to dialyzable nature of acetazolamide.

CONCLUSION: We present a case of a severe DKA potentially precipitated by acute mountain sickness, use of acetazolamide, noncompliance to his regular insulin intake and managed with hemodialysis in addition to conventional treatment for DKA.

© 2020 The Authors.

Keywords: Acute mountain sickness; Diabetes ketoacidosis; Hemodialysis; High altitude

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