A Rare Presentation of Cerebral Edema in Adult-Onset Diabetic Ketoacidosis: Clinical Challenges and Management in a High-Risk Elderly Patient

Abstract

Diabetic ketoacidosis (DKA) is a serious, potentially life-threatening complication of diabetes mellitus, characterized by hyperglycemia, metabolic acidosis, and ketonemia. While more common in type 1 diabetes, DKA is increasingly seen in patients with type 2 diabetes, accounting for nearly one-third of cases. Cerebral edema, although rare in adults, represents a grave complication of DKA that can result in significant morbidity and mortality. This case report discusses a 74-year-old female with a history of poorly controlled type 2 diabetes mellitus, hypertension, ischemic stroke, and hypothyroidism, who presented to the emergency department with generalized tonic-clonic seizures and involuntary movement of the right lower limb. On examination, she was somnolent and disoriented. Laboratory evaluation revealed severe DKA, with associated electrolyte abnormalities and hyperosmolarity. Neuroimaging showed evidence of cerebral edema, likely contributing to her seizure activity. Immediate intensive care management was initiated, including intravenous fluids, continuous insulin infusion, electrolyte correction, osmotherapy for cerebral edema, and antiepileptic therapy. Over the following 48 hours, her metabolic parameters improved, and her neurological status gradually stabilized. She remained seizure-free on maintenance antiepileptic medication and was transferred to the general ward in stable condition. This case highlights the importance of early recognition and aggressive management of DKA and its complications, particularly in elderly patients with multiple comorbidities. A multidisciplinary approach, including fluid resuscitation, insulin therapy, neurological monitoring, and patient education, is essential to improve outcomes and prevent recurrence. Clinicians should maintain a high index of suspicion for cerebral edema in DKA patients presenting with altered mental status or seizures.

Keywords: Diabetic Ketoacidosis (DKA), Cerebral Edema, Type 2 Diabetes Mellitus, Seizures, Elderly Patient