Case presentation A 34-year-old woman with a known history of type 1 diabetes mellitus (T1DM) presented to the emergency department with marked lethargy and episodes of coffee-ground emesis. Although significantly fatigued, she remained conscious and oriented. She reported multiple previous episodes of diabetic ketoacidosis (DKA), each occurring around the onset of her menstrual cycle.
At the time of this admission, she was on the third day of menstruation and stated that she had been compliant with her prescribed insulin regimen. Her symptoms included nausea, abdominal pain, tachypnea, and a dry cough. Medical history Recurrent episodes of DKA temporally linked to the menstrual cycle Dysmenorrhea Iron deficiency anemia Hematemesis Hiatal hernia Diabetic gastroparesis Laboratory evaluation Hyperglycemia (Serum glucose level: 716 mg/dL) Elevated beta-hydroxybutyrate (125 mg/dL) Increased…
