Unexpected cause of recurrent diabetic ketoacidosis in type 1 diabetes: A case report

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Rabia Khalid Alduraibi*, Yosef Fahad Altowayan and Bader Tha’ar AlMharwal

King Fahad Specialist Hospital, KSA

: Endocrinol Diabetes Res

Abstract

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Gastrointestinal (GI) symptoms are commonly observed in patients with diabetic ketoacidosis (DKA), which usually resolves completely with therapy. However, GI symptoms can persist after DKA resolves, which can pose diagnostic and management challenges for physicians, especially when dealing with an exceptional diagnosis such as cannabinoid hyperemesis syndrome (CHS). Case presentation: in this case report, we present a patient with type 1 diabetes who had been treated for DKA 6 times in the past year and was eventually diagnosed with CHS. Conclusion: in conclusion, this case demonstrates that a presumptive and incorrect diagnosis can mislead physicians, especially when dealing with challenging diagnoses. Therefore, patients with type 1 diabetes with unusual presentations, such as unexpectedly high pH and bicarbonate levels, with hyperglycemic ketosis should be screened for illicit drug use, especially cannabis. Keywords: Diabetic ketoacidosis, Cannabinoid hyperemesis syndrome, Type 1 diabetes, Cannabis. Recent Publications: 1. United Nations. World Drug Report 2019; Cannabis and hallucinogens. 2019. Retrieved from https:// wdr.unodc.org/wdr2019/en/cannabis-and- hallucinogens.html. 2. Alshmrani S. 7% of Saudis are drug users. Saudi Arabia: Al-Hayat; Newspa- per 2017. 3. Al-Musa HM, Al-Montashri SDS. Substance abuse among male secondary school students in Abha city, Saudi Arabia: prevalence and associated factors. Biomed Res. 2016;27:1364–73. 4. Ibrahim Y, Hussain SM, Alnasser S, Almohandes H, Sarhandi I. Patterns and sociodemographic characteristics of substance abuse in Al Qassim, Saudi Arabia: a retrospective study at a psychiatric rehabilitation center. Ann Saudi Med. 2018;38(5):319–25. 5. Akturk HK, Taylor DD, Camsari UM, Rewers A, Kinney GL, Shah VN. Associa- tion between cannabis use and risk for diabetic ketoacidosis in adults with type 1 diabetes. JAMA Intern Med. 2019;179:115–8.

Biography

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Alduraibi has completed her Medical school from Qassim University and Family medicine resident from King Saud University Hospital. She is currently Diabetes follow at King Fahad Specialist Hospital.