Massive pulmonary embolism in diabetic ketoacidosis and non-ketotic hyperosmolar state: case series and review of the literature

Abstract

Objective: To describe three acutely decompensated diabetic patients who suffered massive pulmonary embolism within 72 hours of admission.Design: Case series and literature review.Setting: University-affiliated urban hospital center.Patients: Three patients with severe hyperglycemia and ketoacidosis or hyperosmolar state who developed massive pulmonary embolism.Interventions: Intravenous heparin, recombinant tissue plasminogen activator, advanced cardiac life support.Results: Massive pulmonary embolism proved rapidly fatal in the two cases that manifested as pulseless electrical activity cardiac arrest.Conclusions: Critical care clinicians must recognize the potential for massive, life-threatening pulmonary embolization in patients with decompensated diabetes.