Skip to main content Skip to main navigation menu Skip to site footer

Severe diabetic ketoacidosis with cerebral edema and acute kidney failure: a case report

Abstract

Background: In 2018, the Indonesian Pediatric Society stated that there were 1,220 children suffering from Type 1 Diabetes Mellitus. This might be an iceberg phenomenon due to a large number of children and adolescents in Indonesia. Diabetic ketoacidosis is one of the Type 1  Diabetes Mellitus acute complications that could be fatal. The problem is that our society isn't familiar with this condition, and it leads to delayed diagnosis and treatment.

Case: A 16 – year – old girl was hospitalized due to right lower abdominal pain, nausea, vomiting, decreased appetite, and fever for 3 days. The next morning, she became unconscious with a Glasgow Coma Scale of E1V1M6. Her blood tests showed blood glucose levels of 551 mg/dL, C – Peptide of 0,65 ng/mL, pH of 6,81, and cHCO3 of 3 mmol/L. Her urine tests showed ketonuria of +4. She was diagnosed with Severe Diabetic Ketoacidosis and Cerebral Edema. She received 8 litre/minute of O2 NRM, 10 ml/kg of 0,9% NaCl in 1 hour continued with 1,5 times maintenance need + 5 mmol/kg/day of KCl, 0,1 IU/kg/hour of insulin, and 1 g/kg of mannitol. Renal function monitoring showed daily increases in serum creatinine to 9,2 mg/dL on the day – 7. This pre-renal acute kidney injury was thought to be due to dehydration. She was then referred to a higher-level hospital for hemodialysis.

Conclusions: Diabetic Ketoacidosis in children shows a wide range of clinical manifestations. Therefore, awareness of this condition is of utmost importance in reducing patients' morbidity and mortality.

Section

References

  1. Pulungan AB, Annisa D, Imada S. Diabetes Melitus Tipe-1 pada Anak: Situasi di Indonesia dan Tata Laksana (Type 1 diabetes mellitus in children: situation and management in Indonesia). Sari Pediatr. 2019;20(6):392.
  2. Garg RK, Vimalananda V. Type 1 diabetes mellitus. Joslin's Diabetes Mellit Fourteenth Ed. 2021;399–424.
  3. Mobasseri M, Shirmohammadi M, Amiri T, Vahed N, Hosseini Fard H, Ghojazadeh M. Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis. Health Promot Perspect. 2020;10(2):98-115. Published 2020 Mar 30. doi:10.34172/hpp.2020.18.
  4. Listianingrum L, Patria SY, Wibowo T. Predictive factors of ketoacidosis in type 1 diabetes mellitus. Paediatr Indones. 2019;59(4):169–74. doi: https://doi.org/10.14238/pi59.4.2019.169-74.
  5. Ikatan Dokter Anak Indonesia (IDAI). Buku Ajar Endokrinologi Anak Edisi Kedua. 2018.
  6. Maahs DM, West NA, Lawrence JM, Mayer-Davis EJ. Epidemiology of type 1 diabetes. Endocrinol Metab Clin North Am. 2010;39(3):481-497. doi:10.1016/j.ecl.2010.05.011.
  7. Chowdhury S. Puberty and type 1 diabetes. Indian J Endocrinol Metab. 2015;19(Suppl 1):S51-S54. doi:10.4103/2230-8210.155402.
  8. Al-Fifi SH. The relation of age to the severity of Type I diabetes in children. J Family Community Med. 2010;17(2):87-90. doi:10.4103/1319-1683.71990.
  9. Cardwell CR, Stene LC, Ludvigsson J, et al. Breast-feeding and childhood-onset type 1 diabetes: a pooled analysis of individual participant data from 43 observational studies. Diabetes Care. 2012;35(11):2215-2225. doi:10.2337/dc12-0438.
  10. Khashan AS, Kenny LC, Lundholm C, Kearney PM, Gong T, Almqvist C. Mode of obstetrical delivery and type 1 diabetes: a sibling design study. Pediatrics. 2014;134(3):e806-e813. doi:10.1542/peds.2014-0819.
  11. Stene LC, Magnus P, Lie RT, Søvik O, Joner G; Norwegian childhood Diabetes Study Group. Birth weight and childhood onset type 1 diabetes: population based cohort study. BMJ. 2001;322(7291):889-892. doi:10.1136/bmj.322.7291.889.
  12. Ludvigsson J. The jury is still out on possible links between cows' milk and type 1 diabetes. Acta Paediatr. 2020;109(2):231-232. doi:10.1111/apa.14756.
  13. Ikatan Dokter Anak Indonesia. Pedoman Pelayanan Medis. IDAI. 2010. p1-344.
  14. Ikatan Dokter Anak Indonesia. Konsesus Nasional Pengelolaan Diabetes Melitus tipe 1 [Internet]. 2015. 6–36 p. Available from: http://www.idai.or.id/wp content/uploads/2016/06/Konsensus Endokrin DM tipe 1 (2015).pdf
  15. Levin DL. Cerebral edema in diabetic ketoacidosis [published correction appears in Pediatr Crit Care Med. 2009 May;10(3):429]. Pediatr Crit Care Med. 2008;9(3):320-329. doi:10.1097/PCC.0b013e31816c7082.
  16. Hursh BE, Ronsley R, Islam N, Mammen C, Panagiotopoulos C. Acute Kidney Injury in Children With Type 1 Diabetes Hospitalized for Diabetic Ketoacidosis. JAMA Pediatr. 2017;171(5):e170020. doi:10.1001/jamapediatrics.2017.0020.
  17. Ikatan Dokter Anak Indonesia. Pedoman Pelayanan Medis Edisi II. IDAI. 2011. p1-360.
  18. Walters S, Porter C, Brophy PD. Dialysis and pediatric acute kidney injury: choice of renal support modality. Pediatr Nephrol. 2009;24(1):37-48. doi:10.1007/s00467-008-0826-x.

How to Cite

Hsieh, P. P., Wijaya, T., Melinda, F., & Suryawan, I. W. B. (2022). Severe diabetic ketoacidosis with cerebral edema and acute kidney failure: a case report. Indonesia Journal of Biomedical Science, 16(1), 61–65. https://doi.org/10.15562/ijbs.v16i1.358

HTML
48

Total
18

Share

Search Panel