Successful Treatment of Pulmonary Embolus Secondary to Diabetic Ketoacidosis with Tissue Plasminogen Activator

A 75-year-old woman with a history of Type 2 Diabetes mellitus attended triage with complaints of nausea, occasional vomit, pain in epigastrium and some vague heaviness in breathing of 4-5 days duration. On her physical examination she had mild tachypnea, peripheral capillary oxygen saturation (SpO2) 92% on room air, and high blood glucose and ketones respectively. She was evaluated and diagnosed to have bilateral submassive pulmonary Thromboemboli.

She was managed with fibrinolytic treatment, Heparin, and supportive treatment along with management of Diabetic Ketoacidosis (DKA). Etiological examinations did not reveal any underlying cause. The contribution of diabetes and its acute complication, DKA, to the development of pulmonary thromboembolism is controversial and is discussed. This case with the presentation of sub-massive pulmonary embolism in a patient of DKA with no underlying cause identified is being reported owing to its rareness.