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Sudden Death Due to Hypercoagulability in a
Patient With Pancreatic Cancer and Diabetic
Ketoacidosis
1 1 2 2
Esther Park , Milenko T. Petrovic , Nidal Shah , Rahul Sharma
Review began 04/03/2025
Review ended 04/19/2025
Published 04/28/2025
© Copyright 2025
Park et al. This is an open access article
distributed under the terms of the Creative
Commons Attribution License CC-BY 4.0.,
which permits unrestricted use, distribution,
and reproduction in any medium, provided
the original author and source are credited.
DOI: 10.7759/cureus.83152
1. Pathology, University of Arkansas for Medical Sciences, Little Rock, USA for Medical Sciences, Little Rock, USA
2. Internal Medicine, University of Arkansas
Corresponding author: Esther Park, ecpark@uams.edu
Abstract
Pancreatic cancer is a significant contributor to cancer-related mortality, with an increasing incidence
linked to an aging population. A rare complication of pancreatic cancer is diabetic ketoacidosis (DKA),
which arises from the tumor’s impairment of insulin production. DKA can also present alongside other
challenges such as malnutrition and hypercoagulability. This study describes a 67-year-old female patient
with a past medical history of type 2 diabetes who presented with DKA and was later diagnosed with a
pancreatic mass suggestive of malignancy. She developed multiple venous thrombi and subsequent
pulmonary emboli, leading to sudden death. Autopsy revealed extensive occlusive thrombi and ischemic
changes, emphasizing the potentially life-threatening interactions between DKA, malignancy-associated
hypercoagulability, and metabolic derangements of pancreatic cancer. This study reinforces the need for
careful monitoring and management of thrombotic events in patients with multiple comorbidities.
Categories: Internal Medicine, Anesthesiology, Oncology
Keywords: acute pulmonary embolism, code status, diabetic ketoacidosis (dka), endoscopy, fatal outcome,
malignancy-associated hypercoagulability, pancreatic cancer, type 2 diabetes mellitus
Introduction
Pancreatic cancer is a leading cause of cancer-related mortality, with a prevalence that has doubled over the
past 25 years [1]. As the United States population ages, its incidence has risen [2]. A rare but severe
complication in the context of pancreatic cancer is diabetic ketoacidosis (DKA), an acute and life-
threatening complication of diabetes [3,4]. DKA is not only linked to long-standing diabetes but also
inducible by pancreatic tumors disrupting insulin production, leading to pancreatogenic diabetes mellitus.
Compromise of the pancreas can result in pancreatogenic diabetes mellitus, which arises due to destruction
of insulin-producing islet cells [5]. DKA in the setting of pancreatic cancer presents unique challenges, since
patients can suffer from malnutrition, dehydration, cachexia, and hypercoagulability [6,7]. Pancreatic
adenocarcinomas also predispose patients to hypercoagulability, increasing venous thromboembolism (VTE)
risk due to tumor-derived procoagulant factors [8]. This case examines the sudden death of a patient with
pancreatic cancer and DKA secondary to hypercoagulation. In addition, this study functions to remind
clinicians of the importance of early recognition for management and outcomes of patients with pancreatic
cancer.
Case Presentation
This 67-year-old female with a history of type 2 diabetes mellitus, hypertension, binge-eating disorder,
hypothyroidism, and laparoscopic cholecystectomy presented to an outside hospital with abdominal pain,
confusion, nausea, and vomiting. She was diagnosed with DKA and a urinary tract infection (UTI) leading to
sepsis, treated with an insulin drip, fluids, and ceftriaxone. Labs were obtained at this time to rule out sepsis,
PE, and cardiac causes. These values are summarized in Table 1.

https://assets.cureus.com/uploads/case_report/pdf/351659/20250429-139135-b4gb4v.pdf

由于超凝性而突然死亡

胰腺癌和糖尿病患者
酮症酸中毒
1 1 2 2
Esther Park，Milenko T. Petrovic，Nidal Shah，Rahul Sharma
评论开始于20125年4月3日
评论于2010年4月19日结束
出版于20125年4月28日
©版权所有2025
Park等。 这是一篇开放访问文章
根据创意的条款分发
Commons归因许可证CC-BY 4.0。
这允许无限制的使用，分发，
并在任何媒介中繁殖
原始作者和资料来源是值得称赞的。
doi：10.7759/cureus.83152
1。阿肯色大学医学科学大学病理学，美国小石城，美国小石城
2。阿肯色大学内科
通讯作者：Esther Park，ecpark@uams.edu
抽象的
胰腺癌是导致癌症相关死亡率的重要原因，发病率增加
与人口老龄化有关。 胰腺癌的罕见并发症是糖尿病性酮症酸中毒（DKA），
这是由于肿瘤的胰岛素产生损害。 DKA也可以与其他
营养不良和高凝性等挑战。 这项研究描述了一名67岁的女性患者
与DKA一起出现的2型糖尿病的过去病史，后来被诊断出患有
胰腺质量暗示了恶性肿瘤。 她发展了多个静脉血栓，随后出现
肺栓塞，导致猝死。 尸检揭示了广泛的闭塞血栓和缺血性
变化，强调DKA，恶性相关的潜在威胁生命的相互作用
胰腺癌的高凝性和代谢危险。 这项研究加强了对
仔细监测和管理多种合并症患者的血小板事件。
类别：内科，麻醉学，肿瘤学
关键词：急性肺栓塞，代码状态，糖尿病性酮症酸中毒（DKA），内窥镜检查，致命结果，
恶性相关的高凝性，胰腺癌，2型糖尿病
介绍
胰腺癌是与癌症相关死亡率的主要原因，患病率增加了一倍
过去25年[1]。 随着美国人口的年龄，其发病率上升[2]。 罕见但严重的
胰腺癌背景下的并发症是糖尿病性酮症酸中毒（DKA），急性和生命 -
威胁糖尿病并发症[3,4]。 DKA不仅与长期存在的糖尿病有关
胰腺肿瘤可诱导，破坏胰岛素的产生，导致胰腺生成糖尿病。
胰腺的妥协可能导致胰糖尿病，这是由于破坏而引起的
产生胰岛素的胰岛细胞[5]。 DKA在胰腺癌的环境中提出了独特的挑战，因为
患者可能患有营养不良，脱水，恶病质和高凝性[6,7]。 胰
腺癌还使患者易于高凝性，增加了静脉血栓栓塞（VTE）
由于肿瘤衍生的突发因子而引起的风险[8]。 此案检查患者的突然死亡
胰腺癌和继发于高凝的DKA。 此外，这项研究起着提醒的作用
早期认可对管理和胰腺患者结果的重要性的临床医生
癌症。
案例表现
这位67岁的女性患有2型糖尿病病史，高血压，暴饮暴食疾病，
甲状腺功能减退症和腹腔镜胆囊切除术置于腹痛的外部医院，
混乱，恶心和呕吐。 她被诊断出患有DKA和尿路感染（UTI）
败血症，用胰岛素滴水，液体和头孢曲松治疗。 目前获得了实验室，以排除败血症，
PE和心脏原因。 这些值总结在表1中。