Anaphylaxis-induced diabetic ketoacidosis

Allergic reactions and complications of diabetes mellitus are commonly seen in emergency departments and primary care settings. Although stress is a known contributor to the development of diabetic ketoacidosis (DKA), anaphylaxis-induced DKA has not previously been described. The case of a type 1 diabetic woman who presented with anaphylaxis secondary to seafood ingestion and subsequently developed DKA is reported. It was concluded that stress and counter-regulatory hormones released during anaphylaxis, as well as the treatment with epinephrine and glucocorticoids, precipitated DKA in this patient despite ongoing insulin and fluid therapy. Type 1 diabetic patients experiencing anaphylaxis may require prolonged periods of observation and measurement of serial blood glucose and urine ketones.