Management of Sepsis Patient Aggravated by Diabetic Ketoacidosis
Abstract
Sepsis is a life-threatening organ dysfunction caused by dysregulation of the host's response to infection. Sepsis can lead to ketoacidosis in diabetes mellitus patients. A 60 years old male complained of headache, mild fever and painful swallowing since 2 weeks prior to hospital admission. History of diabetes mellitus is unknown. Based on examination, the working diagnosis for the patient was sepsis, suspected periapical abscess, type II diabetes mellitus with diabetic ketoacidosis and decreased consciousness. Initial management of sepsis, insulin, and endotracheal intubation were performed. The patient then was admitted to the ICU. Management of sepsis is very important and should be performed based on 1-hour SSC bundle while performing management of DKA. The patient had periapical abscess which is thought to be the source of sepsis. Sepsis then triggers DKA, and several organ dysfunctions in the form of AKI, DIC, and respiratory distress.
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Introduction
Sepsis is a life-threatening organ dysfunction caused by dysregulation of the host's response to infection. Organ dysfunction is identified using the Sequential Organ Failure Assessment score (SOFA score). SOFA score equal to or more than 2 reflect a risk of death of around 10%. This requires prompt and appropriate intervention so that the condition does not get worse1 .
Sepsis can lead to ketoacidosis in diabetes mellitus patients. More than 50% of KAD cases are thought to be triggered by infection. Diabetic ketoacidosis is an acute metabolic disorder characterized by increasing circulating ketone bodies which progresses to ketoacidosis with uncontrolled hyperglycemia due to insulin deficiency. Acidic ketone bodies are produced by lipolysis process. Acidosis occurs when ketone levels exceed the body's buffer capacity. During an infection there will be an increase in the secretion of cortisol and glucagon hence there is a significant increase in blood sugar levels1 .
Conclusion
In this case, a patient had a dental infection that progressed to periapical abscess, and acute otitis media with sphenoid sinusitis and mastoiditis. This is thought to be the source of spread of meningitis and sepsis. Sepsis then triggers KAD, and several organ disfunction in the form of AKI, DIC and respiratory distress.