title: Diabetic ketoacidosis as first presentation of latent autoimmune diabetes in adult.
abstract: A 54-year-old white female with hypothyroidism presented with abdominal pain, nausea, vomiting, and diarrhea. She was found to have diabetic ketoacidosis (DKA) and admitted to our hospital for treatment. Laboratory workup revealed positive antiglutamic acid decarboxylase antibodies and subsequently she was diagnosed with latent onset autoimmune diabetes in adult (LADA). She was successfully treated with insulin with clinical and laboratory improvement. Diagnosis of LADA has been based on three criteria as given by The Immunology of Diabetes Society: (1) adult age of onset (>30 years of age); (2) presence of at least one circulating autoantibody (GADA/ICA/IAA/IA-2); and (3) initial insulin independence for the first six months. The importance of this case is the unlikely presentation of LADA. We believe that more research is needed to determine the exact proportion of LADA patients who first present with DKA, since similar cases have only been seen in case reports. Adult patients who are obese and have high blood sugar may deserve screening for LADA, especially in the presence of other autoimmune diseases. Those patients once diagnosed with LADA need extensive diabetic education including potentially serious events such as diabetic ketoacidosis.
authors.affiliation: Internal Medicine Department, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA.
authors.forename: Omar
authors.identifier: 0000-0002-7336-0643
authors.initials: O
authors.lastname: Nadhem
authors.affiliation: Internal Medicine Department, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA.
authors.forename: Essam
authors.initials: E
authors.lastname: Nakhla
authors.affiliation: Internal Medicine Department, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Smalligan
references.citation: J Clin Endocrinol Metab. 2000 Jan;85(1):76-80
references.pmid: 10634367
references.citation: Diabetes Care. 2013 Apr;36(4):908-13
references.pmid: 23248199
references.citation: Rev Med Chil. 2001 Aug;129(8):853-60
references.pmid: 11680958
references.citation: Diabetes Metab Res Rev. 2012 Dec;28 Suppl 2:40-6
references.pmid: 23280865
references.citation: Diabetologia. 2005 Nov;48(11):2206-12
references.pmid: 16193284
references.citation: Clin Endocrinol (Oxf). 2011 May;74(5):587-92
references.pmid: 21470281
references.citation: Diabetes. 2005 Dec;54 Suppl 2:S68-72
references.pmid: 16306343
references.citation: Am J Ther. 2010 May-Jun;17(3):284-7
references.pmid: 20224323
references.citation: Curr Diab Rep. 2008 Apr;8(2):94-100
references.pmid: 18445350
references.citation: Autoimmun Rev. 2014 Apr-May;13(4-5):403-7
references.pmid: 24424179
references.citation: Med J Malaysia. 2012 Feb;67(1):116-7
references.pmid: 22582562
references.citation: World J Diabetes. 2010 Sep 15;1(4):111-5
references.pmid: 21537436
references.citation: Postgrad Med. 2005 Mar;117(3):7-12
references.pmid: 15782668