Abstract
Diabetic ketoacidosis is rarely reported as a pneumomediastinum or pneumopericardium complication, but physicians should check for this possibility in subjects such as ours. A 43-year-old man admitted for vomiting, back pain, and general fatigue was found in laboratory findings on admission to have plasma glucose of 657 mg/dl, HbA1c of 7.7%, arterial gas indicating metabolic acidosis, and a high urine ketone body count. C-peptide serum of 0.1 ng/ml and urine of 3.1 μg/day were markedly decreased. An intravenous glucagon injection of 1 mg produced no significant serum C-peptide increase, which increased from 0.1 ng/ml to 0.2 ng/ml after six minutes, indicating severely impaired insulin secretion. Glutamic acid decarboxylase autoantibodies, insulinoma-associated protein 2, and islet cell testing were negative. Plain and chest computed tomography (CT) showed a small amount of gas accumulated in the mediastinum and pericardium, yielding a diagnosis of fulminant type 1 diabetes mellitus associated with Hamman syndrome. Treatment with intravenous fluid and insulin significantly improved symptoms and pneumomediastinum and pneumopericardium by day 16.
