Mitra NİAFAR, Habib ERENSOY, Sepideh TAHSINI TEKANTAPEH

Yineleyen diyabetik ketoasidoz benzeri belirtiler ve yapay hiperglisemi, diyabet tip I ve Munchausen sendromu birlikteliği: Olgu sunumu

Yapay bozukluk, bir hastalığın klinik belirtilerin hasta tarafından bilerek hasta rolünü benimsemek için ortaya çıkartan psikiyatrik bir hastalıktır. Kontrol edilemeyen diyabet melitus hastalarında bazen neden yapay bozukluktur. Bu makalede kan şekeri kontrol edilemeyen 17 yaşında diyabetli bir kızı sunuyoruz. Yüksek kan şekeri ve bazen diyabetik ketoasidoz belirtiler gösteren hastada dikkatli izleme sonucunda şeker ölçümü öncesi parmağına hurma sürüp kan şekerin yüksek çıkmasına neden olarak hastanede kalmak için yaptığı ortaya çıkmıştır. Bu yazıda kan şekeri kontrol edilemeyen diyabetik hastalarda yapay bozukluğun ayrıcı tanılar arasında gözden kaçırılmaması gerektiğini belirtiyoruz.

Recurrent diabetic ketoacidosis-like symptoms and factitious hyperglycemia as a Munchausen syndrome in diabetes mellitus type 1: a case report

Factitious disorder is a psychologic problem which may cause symptoms of a disease which is non-compliance with patient physical exam. Some cases of brittle diabetes are because of underlying psychologic disorder such as factitious disorder or Munchausen syndrome. In this paper a 17-years old female is presented with factitious hyperglycemia and DKA-like symptoms such as nausea, vomiting and severe abdominal pain. Finally with subtle monitoring it was found that the cause of patient's hyperglycemia despite high dose insulin prescription was impregnating her finger into the date palm in the context of the factitious disorder. The patient had different deceptive behaviors depending on the method of treatment. She used every trick to mislead the medical team. In Munchausen syndrome, patient is unaware of his problem that mimic an episode of diabetic ketoacidosis. Thus psychotherapy is the main treatment of this factitious hyperglycemia. The main aim of this report is consideration of factitious hyperglycemia in patients with brittle diabetes mellitus.

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