Subarachnoid Hemorrhage: A Rare but Devastating Complication of Diabetic Ketoacidosis
https://doi.org/10.15605/jafes.041.S1
- Author:
Hui Min Tan
1
;
Mohd Irfan bin Moktar
1
;
Hwee Ching Tee
2
Author Information
1. Department of Medicine, Hospital Beaufort
2. Department of Medicine, Hospital Queen Elizabeth II
- Publication Type:Journal Article
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):56-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Diabetic ketoacidosis (DKA) is a common complication
of type 1 diabetes mellitus (T1DM). Neurological complications of DKA are rare in adults. We report a case of young
lady with T1DM who presented with severe DKA and
complicated with subarachnoid hemorrhage (SAH).
Case:A 19-year-old female was diagnosed with T1DM following
an admission for DKA 2 months earlier. Her hemoglobin
A1c was 17.2%, and autoimmune markers showed positive
anti-glutamic acid decarboxylase (anti-GAD) antibodies (71
IU/mL) with negative anti-insulinoma-associated antigen
2 (anti-IA2) and islet cell antibodies. Her C-peptide level
was low at 69 pmol/L. She was discharged with basal bolus
insulin analogues, but she defaulted on her medications.
She presented to the hospital 2 months later with a history
of epigastric pain, vomiting, and breathlessness for 2 days,
and was then found unconscious at home. There was no
history of trauma. She was intubated for a poor Glasgow
Coma Scale (E1V1M1). Blood results showed severe DKA
with glucose 25 mmol/L, blood gas pH 6.572, bicarbonate 2.6
mmol/L, and ketone more than 8.8 mmol/L. She was started
on insulin infusion and fluid resuscitation. DKA resolved
after 24 hours. Computed tomography (CT) of the brain
showed SAH in the right frontal and left frontotemporal
regions. CT angiography of the brain reported no evidence
of an intracranial aneurysm. She was extubated on day
4 of admission. Subsequent cerebral digital subtraction
angiography was unremarkable. The patient achieved
complete neurological recovery on follow-up.
Conclusion:This case highlights that severe DKA may rarely be
associated with spontaneous SAH, which increases
morbidity and mortality. Proposed mechanisms include
vascular injury, oxidative stress from severe ketoacidosis,
and endothelial dysfunction related to inflammatory
mediators. Clinicians should have a high suspicion and
consider neuroimaging in DKA patients with unexplained
reduced consciousness or atypical neurological findings.
- Full text:2026073016343012929EP_A067.pdf
