Authors: Milan Djordjevic

Abstract

Background: Diabetic ketoacidosis (DKA) is an acute complication of diabetes, a severe metabolic disorder that requires urgent treatment. The aim of this article is to present a case of steroid-induced diabetes with complications.

Case presentation: A young 25-year-old man without any co-morbid, presented to the emergency department with fever, vomiting, coughing, and buttock pain which started 3 days before. On the right gluteus, there was a hematoma approx. 10 × 5 cm with fluctuation. The patient had hyperglycemia (9.1 mmol/l), associated with high anion-gap metabolic acidosis, acute kidney injury (AKI), grossly elevated muscle enzymes, hyperkalemia, hyperphosphatemia, hypoalbuminemia, hypocalcemia and hypomagnesemia, and deranged liver function tests. The urine dipstick was grossly cola-colored and biochemically was positive for glucose, ketones, and proteins. Abscess drainage was performed, and Streptococcus pyogenes was isolated on culture and sensitivity. The patient was treated for DKA, complicated by an AKI and infection. Diabetes is confirmed based on glycosylated hemoglobin.

Conclusion: The risk of ketoacidosis and hyperglycemia should be considered in the course of steroid therapy, even without a diagnosis of diabetes, in patients who abuse steroids or have risk factors for diabetes and obesity.

Keywords: Diabetic ketoacidosis, steroids, case report, diabetes mellitus, infection, glycosylated hemoglobin, acute kidney injury, green