Ketoacidosis: Comments on Mechanism, Incidence, and Management*

We describe three cases of pneumomediastinum associated with diabetic ketoacidosis and give reasons why these disorders may coexist more frequentiy than heretofore realized. The pathogenesis of pneumomediastinum in such patients remains obscure. Previous authors have considered the pneumomediastinum to be a consequence of vomiting or hyperpnea accompanying diabetic ketoacidosis, but we point out that it sometimes precedes the onset of the metabolic disturbance. We also acknowledge that the appearance of these entities in the same patient could be coincidental. In each of the I I documented cases so far, primary therapeutic attention to the diabetic ketoacidosis has resulted in an uneventful course and rapid recovery. This experience calls for conservative management of the pneumomediastinum.