title: Severe diabetic ketoacidosis in combination with starvation and anorexia nervosa at onset of type 1 diabetes: a case report.
abstract: We here report a case of diabetic ketoacidosis at onset of type 1 diabetes after a prolonged period of starvation due to anorexia nervosa. A 53-year-old female with a history of anorexia nervosa was admitted to the psychiatric clinic due to psychotic behaviour and inability to take care of herself. Twenty-four hours after admission she was transferred to the clinic of internal medicine due to altered mental status, and laboratory screening revealed a pH of 6.895 and blood glucose concentration of 40 mmol/L. Due to the unusual combination of prolonged starvation and diabetic ketoacidosis we implemented some modifications of existing treatment guidelines and some special considerations regarding nutrition in order to prevent a re-feeding syndrome.
authors.affiliation: Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden. daniel.espes@mcb.uu.se
authors.forename: Daniel
authors.initials: D
authors.lastname: Espes
authors.forename: Joakim
authors.initials: J
authors.lastname: Engström
authors.forename: Henrik
authors.initials: H
authors.lastname: Reinius
authors.forename: Per-Ola
authors.initials: PO
authors.lastname: Carlsson
mesh_terms: D000856:Anorexia Nervosa / Q000150:complications*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology; D016883:Diabetic Ketoacidosis / Q000150:complications*; D005260:Female; D006801:Humans; D008875:Middle Aged; D013217:Starvation
references.citation: Arch Intern Med. 1989 Apr;149(4):877-81
references.pmid: 2650647
references.citation: Paediatr Drugs. 2008;10(4):209-15
references.pmid: 18590342
references.citation: Endocr Pract. 2008 Nov;14(8):1055-63
references.pmid: 19095609
references.citation: Crit Care Med. 1999 Dec;27(12):2690-3
references.pmid: 10628611
references.citation: Diabetes Care. 2002 Nov;25(11):2113-4
references.pmid: 12401775
references.citation: Ann Intern Med. 1986 Dec;105(6):836-40
references.pmid: 3096181
references.citation: Psychiatry Res. 1996 Apr 16;62(1):85-96
references.pmid: 8739118
references.citation: J Clin Invest. 1967 Oct;46(10):1589-95
references.pmid: 6061736
references.citation: Clin Med (Lond). 2006 Sep-Oct;6(5):457-60
references.pmid: 17080892
references.citation: Crit Care Med. 1990 Sep;18(9):1030-3
references.pmid: 2118441
references.citation: Am J Forensic Med Pathol. 2004 Jun;25(2):172-5
references.pmid: 15166774
references.citation: Diabet Med. 2011 May;28(5):508-15
references.pmid: 21255074
references.citation: Diabetes Care. 2009 Jul;32(7):1335-43
references.pmid: 19564476
references.citation: Ann Emerg Med. 2009 Feb;53(2):264-6
references.pmid: 18468728