Diabetic Ketoacidosis–Associated Brain Injury: A Rare but Serious Complication

TL;DR

A rare brain injury linked to diabetic ketoacidosis in an 18-year-old was successfully treated with careful monitoring and metabolic correction.

Contribution

Highlights clinical management strategies for DKA-associated brain injury through a detailed case report.

Findings

Brain MRI showed diffuse cortical and brainstem abnormalities consistent with cytotoxic cerebral edema.

Timely metabolic correction and neuroimaging led to partial regression of lesions and full recovery.

Early recognition and close monitoring improved outcomes in DKA-associated brain injury.

Abstract

Diabetic ketoacidosis (DKA)–associated brain injury is a rare but serious complication, typically occurring early during metabolic correction and associated with a poor prognosis. We report the case of an 18-year-old college student admitted to the intensive care unit with severe DKA, characterized by profound metabolic acidosis and marked electrolyte imbalances, including hypokalemia, hypernatremia, and hyperchloremia. Within hours, she developed altered mental status and generalized seizures. Brain magnetic resonance imaging (MRI) revealed diffuse cortical and brainstem abnormalities, suggestive of cytotoxic cerebral edema. She was managed with continuous sedation, mechanical ventilation, intravenous insulin, potassium supplementation, enteral nutrition, and gradual metabolic correction. Her neurologic status improved within a few days, and follow-up MRI showed partial regression of the lesions. She was subsequently transferred to the endocrinology department and ultimately regained full cognitive and physical function. This case underscores the importance of early recognition, close neurologic monitoring, timely neuroimaging, and tight metabolic and osmotic control to optimize outcomes in patients with DKA-associated brain injury.

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