Occult mucous airway obstruction in diabetic ketoacidosis

Four patients with diabetes mellitus and no underlying clinical pulmonary disease were found to have extensive unilateral mucous occlusion of a major central bronchus. None of the patients had significant auscultatory findings suggestive of pulmonary secretions, and chest roentgenographic films were normal. Arterial blood gas evaluation failed to reveal the usual hypocapnia during ketoacidosis, thus prompting bronchoscopic examination or deep airway suctioning. These interventions disclosed and resolved the mucous obstruction of the compromised bronchus. Antibiotic therapy, based upon bronchial secretion Gram stain and culture, was successfully instituted in all patients. Lethargy and autonomic neuropathy are proposed as contributing factors responsible for occult mucous plugging in diabetic patients in ketoacidosis. The absence of hypocapnia in this setting may be the only clue to silent mucous plugging of airways.