To present a case of diabetic ketoacidosis (DKA) and sepsis-induced cardiomyopathy (SICM) triggered by a periapical abscess in a patient with poorly controlled diabetes, emphasizing the clinical implications of odontogenic infections.
Approach:
Management: The patient received early empiric antibiotics (amoxicillin-clavulanate and tinidazole), aggressive fluid resuscitation, and intravenous insulin infusion. Multidisciplinary source control was implemented.
Key Findings:
The patient had severe DKA with a pH of 7.04 and β-hydroxybutyrate of 7.19 mmol/L.
Echocardiography showed severe left ventricular systolic dysfunction (ejection fraction 36%) consistent with SICM.
Follow-up echocardiography on day 14 showed complete recovery of cardiac function (ejection fraction 72%).
The patient showed rapid clinical improvement, with metabolic acidosis and ketosis resolving and infection markers normalizing.
Interpretation:
Odontogenic infections can trigger DKA and septic shock in diabetic patients, necessitating thorough physical examinations.
Limitations:
The case is a single patient report, limiting generalizability.
Long-term outcomes beyond one month are not reported.
Conclusion:
The case illustrates the critical importance of recognizing odontogenic infections as potential triggers for severe DKA and SICM in diabetic patients.
