A Case Report of New-Onset Type 1 Diabetes Mellitus with Diabetic Ketoacidosis, Deep Vein Thrombosis and Pulmonary Embolism - A Rare Presentation
Abstract Number: 2390-PO
Authors: SONAL R. CHANDRATRE, GHUFRAN BABAR
Institutions: Kansas City, MO
Results: We report a case of a 14 year old caucasian female who presented with a 3 day history of right leg swelling, pain and difficulty in ambulation. She had no respiratory compromise and was maintaining saturations of 97-98% on room air. There was no appreciable weight loss, polyuria, polydipsia and polyphagia. She was started on oral contraceptives (OCP) drospirenone 3 mg/ethinyl estradiol 20 mcg(YAZ®) about 2 months ago. There was no family history of thrombotic disease, diabetes or any other endocrine disorder. Physical exam showed moderate dehydration and physical signs of deep vein thrombosis(DVT). Doppler ultrasound of lower extremity showed occlusive DVT within the right popliteal vein extending to the external iliac vein. Angiographic CT scan of chest indicated left pulmonary embolus. Laboratory investigations showed elevated PT, INR, PTT, D dimers, fibrinogen, low antithrombin 3, negative serum HCG, elevated white blood count and hematocrit. Basic metabolic profile showed a sodium of 130 mEq/L, serum bicarbonate of 10 mEq/L blood glucose of 280 mg/dl with elevated anion gap of 17 mEq/L. Urinalysis indicated 3+ ketones, 3+ glucose with specific gravity of 1.04. She had elevated insulin antibodies(Ab), elevated islet cell autoAb:ICA-512/IA-2 Auto Ab, normal glutamic acid decarboxylase auto-Ab and Hemoglobin A1c of 11.9%. She had normal insulin C-peptide, thyroid hormones and negative celiac screen. Factor V Leiden, prothrombin gene(factor II) variant and 20210G>A mutation was negative. She was treated with intravenous fluids, insulin and heparin. In summary, the profound hypovolemic state due to diabetic ketoacidosis(DKA) and hypercoagulability risk secondary to the usage of OCP as well as type 1 diabetes mellitus with DKA caused DVT and pulmonary embolus. To the best of our knowledge, this is the first reported case of new-onset type 1 diabetes mellitus presenting with this combination of DKA, DVT and pulmonary embolism.