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Warning over diabetic ketoacidosis after man’s death

Warning over diabetic ketoacidosis after man’s death - Featured Image

GPs are being told to consider diabetic ketoacidosis after a man died less than 24 hours after presenting to his doctor.

According to the Victorian Coroner’s report, a 29-year-old male visited his GP complaining of increased urination, thirst and difficulty sleeping.

He had a fever of 38.6 with high blood pressure and the GP prescribed cephalexin antibiotics for a urinary tract infection.

A urine sample was taken and sent to pathology as well as requests for blood tests including full blood exam, LFT, TSH, urea and electrolytes and fasting blood glucose.

However the patient was found dead in his home at 9pm the following day. A taxi was booked at 5:30am that morning however he didn’t respond to the taxi’s arrival at between 7:40am and 8am.

The pathology report dated the day after testing found ketones and glucose in the urine sample.

Related: MJA – Guidance concerning the use of glycated haemoglobin (HbA1c) for the diagnosis of diabetes mellitus

The coroner found that the patient died from diabetic ketoacidosis. Post mortem toxicological analysis showed a glucose concentration of 45mmol/L, combined with raised acetone levels in the blood and vitreous. The coroner said this indicated that the man had died of undiagnosed diabetes.

The patient had reported considerable weight gain over the previous year, resulting in him weighing 122.9kg when he presented to his doctor. The GP concluded that the patient likely had diabetes and ranked the likelihood as Type 2 ahead of Type 1 diabetes. However he didn’t check the patient’s blood glucose at the time, instead referring him for fasting blood tests the next day.

It is noted in the coroner’s report that the GP was regretful that he didn’t perform a fingerprick test at the time of consultation and that it would have been the appropriate action.

The report stated that the doctor was under the impression that fasting blood tests was the most accurate way to diagnose diabetes. “(The doctor) did not consider that (the patient) was in any immediate danger from diabetes,” the report said.

CPD active learning module: Addressing the challenges in the fast moving field of endocrinology

The coroner recommended the following:

  1. The Royal Australian College of General Practitioners provides a clinical update to GPs to highlight the importance of recognising hyperglycaemia and ketosis in adult diabetic patients, as an uncommon but potentially serious complication of type 2 diabetes, or indication of newly recognised adult-onset type 1 diabetes.
  2. The Royal Australian College of General Practitioners advise GPs that although uncommon in adults and clinically subtle in its earliest states, evolving diabetic ketoacidosis may produce a dangerous metabolic decompensation and require escalation of care to a hospital setting for further assessment and management.

RACGP President Dr Frank R Jones told doctorportal: “The RACGP will certainly review and respond to the coroner’s recommendations regarding diabetic ketoacidosis (DKA) as published in the findings into the death of (the patient) and will communicate a clinical update to members.

“The RACGP does have some existing guidance on DKA in its resource General practice management of type 2 diabetes.”

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