Corticosteroid-induced hyperglycemic crisis Crisis hiperglucémica inducida por corticoides

Abstract

Introduction: a hyperglycemic crisis is the most serious acute complication of diabetes mellitus (DM). Precipitating factors are usually infection, intoxication, inflammation, ischemia and iatrogenesis. The latter refers to the intake of drugs such as glucocorticoids, since it is paradoxical that being hyperglycemia, one of the best-known side effects, it is one of the most underestimated. Case presentation: 62-year-old woman with a personal history of idiopathic thrombocytopenic purpura treated with 50 mg of prednisolone a day, who was admitted to the emergency room for presenting somnolence, asthenia and hyporexia, since the last 5 days. Somnolence, grade III dehydration, ketonuria and a 320.48 mOsm/kg urine osmolality, blood glucose level of 1.035 mg/dL and arterial blood gases indicating uncompensated metabolic acidosis, were found. The case was considered a mixed hyperglycemic crisis probably induced by corticosteroids. Insulin therapy and IV hydration were provided with favorable progression. Discussion: glucocorticoids feature multiple adverse manifestations, among which the deleterious effect on carbohydrate metabolism stands out, which may not only exacerbate hyperglycemia in known diabetics, but also facilitate the appearance of DM in patients without a prior diagnosis. Conclusion: establishing the incidence of patients with autoimmune diseases treated with corticosteroids, who develop diabetes mellitus, is required.