137 Views

828 - Euglycemic DKA in a Cervical Spinal Cord Injury Patient in Acute Rehab

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

CB

Claire E. Becker, DO

PGY-2 Resident Physician
Mount Sinai Hospital
New York, New York, United States

Co-Author(s)

SM

Smeet Madhani, n/a

Medical Student
Philadelphia College of Osteopathic Medicine
Philadelphia, Pennsylvania, United States

Presenting Author(s)

KF

Kris Foley, MD

Resident
Mount Sinai Hospital
New York, New York, United States

Case Diagnosis: Euglycemic Diabetic Ketoacidosis

Case Description: We present a 65-year-old male with a history of HTN, HLD, T2DM, CAD, and prior C3-C7 cervical spinal stenosis who initially presented to acute rehabilitation following a C3-C7 posterior decompression, laminectomy, bilateral foraminotomies, and C3-C6 posterior instrumented fusion after sustaining an incomplete cervical spinal cord injury (C5 ASIA C) following a fall down stairs. During rehabilitation, the patient made progress in upper body movements and power wheelchair training. However, three weeks into the rehab course, the patient developed labored breathing, fever, and lethargy, leading to a transfer to the ICU. Workup revealed severe metabolic acidosis secondary to euglycemic DKA, associated with the re-initiation of empagliflozin (Jardiance). The ICU course was further complicated by hypotension, NSTEMI, and acute HFrEF, necessitating management with vasopressors and diuretics. After stabilization, the patient was downgraded and eventually transferred back to acute rehab for ongoing care, with significant deconditioning.

Discussions: This case highlights the complex interplay of acute spinal cord injury management with the comorbid conditions of diabetes, cardiovascular disease, and the potential risks associated with SGLT2 inhibitors. Euglycemic DKA is a rare but serious side effect, particularly in patients with significant comorbidities and those undergoing the physical stress of rehabilitation. The management of such patients requires a multidisciplinary approach, balancing the need for intensive rehabilitation against potential serious metabolic and cardiovascular complications.

Conclusions:
This case illustrates the challenges of managing a patient with multiple comorbidities in an acute rehabilitation setting. The occurrence of euDKA and acute HFrEF significantly complicated the rehabilitation process, but with appropriate medical management and interdisciplinary care, the patient stabilized and able to return to rehabilitation. This serves as a reminder of the importance of vigilance for metabolic complications in patients on SGLT2 inhibitors and the need for a comprehensive approach to managing complex medical conditions in the rehabilitation setting.