Precision Fluid Management in a Severe DKA Patient with Complicated Acute Pancreatitis: Reducing Mortality and Length of ICU Stay
-
Mahmoud Sami Mohammed
,
Eriks Sliders
,
Ashraf Goma Alakkad
,
Osama Ahmed Rashid Ahmed
,
Mostafa Mahmoud Elshahat Saleh
Abstract
Diabetic ketoacidosis (DKA) may become life-threatening when accompanied by acute pancreatitis, sepsis, and acute respiratory distress syndrome (ARDS), resulting in a cascade of inflammation and multi-organ dysfunction. We describe a 70-year-old male with severe DKA complicated by septic shock, ARDS, and multi-organ failure, who required individualized, precision-based fluid therapy. Aggressive but closely titrated resuscitation, guided by dynamic clinical markers, together with early initiation of Continuous Renal Replacement Therapy (CRRT), achieved stabilization. This case highlights the value of adaptive fluid management and timely CRRT in critically ill patients with complex DKA.
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[3] Kamath S, Hammad Altaq H, Abdo T. Management of Sepsis and Septic Shock: What Have We Learned in the Last Two Decades? Microorganisms. 2023;11(9):2231.
[4] Bagshaw SM, Chakravarthi MR, Ricci Z, Tolwani A, Neri M, De Rosa S, et al. Precision Continuous Renal Replacement Therapy and Solute Control. Blood Purif. 2016;42(3):238-47.
[5] Clark WR, Neri M, Garzotto F, Ricci Z, Goldstein SL, Ding X, et al. The future of critical care: renal support in 2027. Crit Care. 2017;21(1):92.
[6] Ziaka M, Exadaktylos A. Fluid management strategies in critically ill patients with ARDS: a narrative review. Eur J Med Res. 2025;30(1):401.
[7] Lee SM, An WS. New clinical criteria for septic shock: serum lactate level as new emerging vital sign. J Thorac Dis. 2016;8(7):1388-90.
[8] Palanidurai S, Phua J, Chan YH, Mukhopadhyay A. P/FP ratio: incorporation of PEEP into the PaO2/FiO2 ratio for prognostication and classification of acute respiratory distress syndrome. Ann Intensive Care. 2021;11(1):124.
[9] Dhatariya KK. The management of diabetic ketoacidosis in adults-An updated guideline from the Joint British Diabetes Society for Inpatient Care. Diabet Med. 2022;39(6):e14788.
[10] Vignon P, Evrard B, Asfar P, Busana M, Calfee CS, Coppola S, et al. Fluid administration and monitoring in ARDS: which management? Intensive Care Med. 2020;46(12):2252-64.
[11] Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564-75.
[12] Tandukar S, Palevsky PM. Continuous Renal Replacement Therapy: Who, When, Why, and How. Chest. 2019;155(3):626-38.
[13] Baeg SI, Lee K, Jeon J, Jang HR. Management for Electrolytes Disturbances during Continuous Renal Replacement Therapy. Electrolyte Blood Press. 2022;20(2):64-75.
[2] Foti Randazzese S, La Rocca M, Bombaci B, Di Pisa A, Giliberto E, Inturri T, et al. Severe Diabetic Ketoacidosis in Children with Type 1 Diabetes: Ongoing Challenges in Care. Children. 2025;12(1):110.
[3] Kamath S, Hammad Altaq H, Abdo T. Management of Sepsis and Septic Shock: What Have We Learned in the Last Two Decades? Microorganisms. 2023;11(9):2231.
[4] Bagshaw SM, Chakravarthi MR, Ricci Z, Tolwani A, Neri M, De Rosa S, et al. Precision Continuous Renal Replacement Therapy and Solute Control. Blood Purif. 2016;42(3):238-47.
[5] Clark WR, Neri M, Garzotto F, Ricci Z, Goldstein SL, Ding X, et al. The future of critical care: renal support in 2027. Crit Care. 2017;21(1):92.
[6] Ziaka M, Exadaktylos A. Fluid management strategies in critically ill patients with ARDS: a narrative review. Eur J Med Res. 2025;30(1):401.
[7] Lee SM, An WS. New clinical criteria for septic shock: serum lactate level as new emerging vital sign. J Thorac Dis. 2016;8(7):1388-90.
[8] Palanidurai S, Phua J, Chan YH, Mukhopadhyay A. P/FP ratio: incorporation of PEEP into the PaO2/FiO2 ratio for prognostication and classification of acute respiratory distress syndrome. Ann Intensive Care. 2021;11(1):124.
[9] Dhatariya KK. The management of diabetic ketoacidosis in adults-An updated guideline from the Joint British Diabetes Society for Inpatient Care. Diabet Med. 2022;39(6):e14788.
[10] Vignon P, Evrard B, Asfar P, Busana M, Calfee CS, Coppola S, et al. Fluid administration and monitoring in ARDS: which management? Intensive Care Med. 2020;46(12):2252-64.
[11] Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564-75.
[12] Tandukar S, Palevsky PM. Continuous Renal Replacement Therapy: Who, When, Why, and How. Chest. 2019;155(3):626-38.
[13] Baeg SI, Lee K, Jeon J, Jang HR. Management for Electrolytes Disturbances during Continuous Renal Replacement Therapy. Electrolyte Blood Press. 2022;20(2):64-75.
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| Issue | Article in Press |
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| Section | Case Report(s) | |
| Keywords | ||
| Diabetic Ketoacidosis Fluid Management CRRT ARDS Septic Shock | ||
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How to Cite
1.
Mohammed M, Sliders E, Alakkad A, Ahmed O, Saleh M. Precision Fluid Management in a Severe DKA Patient with Complicated Acute Pancreatitis: Reducing Mortality and Length of ICU Stay. Arch Anesth & Crit Care. 2025;.
