Thirty-two Fatal Cases of Severe Diabetic Ketoacidosis, Including a Case of Mucormycosis

There were thirty-two fatalities in 340 episodes of severe diabetic ketoacidosis occurring in 257 subjects during a three year period. Five patients expired within three hours of admission, before adequate therapy could be started. Causes of death were multiple and complex in certain patients— primary causes were classified as myocardial infarction in seven, pulmonary edema due to coronary arteriosclerosis in one, pneumonia or pneumonitis in eight, cerebrovascular accident in three, acute renal failure in two, gram-negative septicemia in two, acute pancreatitis in two, uncomplicated severe diabetic ketoacidosis in four, carcinoma of pancreas with metastases in one, hyperthyroidism (thyroid “storm”) in one, and mucormycosis in one. This patient expired despite correction of the ketoacidosis and a course of amphotericin B therapy. Insulin resistance, pyelonephritis, gangrene of the leg, diabetic intracapillary glomerulosclerosis, and hepatic cirrhosis also contributed to fatalities in this series of cases.