Noncardiogenic pulmonary edema complicating diabetic ketoacidosis

To alert physicians to the possibility of pulmonary edema as a complication of diabetic ketoacidosis.

We report a case of adult respiratory distress syndrome after resuscitative efforts to compensate the first episode of diabetic ketoacidosis in a previously healthy young woman.

In a 26-year-old woman with a 3-day history of malaise, polyuria, nausea, and vomiting, severe hypoxia and rales developed, and intubation and mechanical ventilation became necessary. Hemodynamic evaluation and striking electron microscopic findings on open-lung biopsy confirmed the diagnosis of adult respiratory distress syndrome. Despite adequate ventilatory support and hemodynamic management, death ensued and was attributed to irresponsive and progressive acute respiratory failure due to increased pulmonary capillary permeability edema.

Clinicians should be aware of this possibly fatal pulmonary complication of diabetic ketoacidosis.