Relapse of diabetic ketoacidosis secondary to insulin pump malfunction diagnosed by capillary blood 3-hydroxybutyrate: a case report

A 14 year old female with type 1 diabetes mellitus and a subcutaneous insulin pump was treated for diabetic ketoacidosis presumed secondary to dietary indiscretion, and then restarted her subcutaneous insulin pump after exchanging the tubing. An hour later, nursing review determined that she was using outdated insulin in the pump, and it was exchanged. However, 5 hours later relapse was suggested by a rise in capillary blood 3-hydroxybutyrate, in spite of a normal serum anion gap and a minimal increase in serum bicarbonate. Insulin pump failure was suspected, and the patient was treated for relapse of diabetic ketoacidosis. Following resolution, her insulin pump was replaced without further complications. Capillary blood levels of 3-hydroxybutyrate may be sensitive, early indicators of relapse of diabetic ketoacidosis, and are easily obtained.