Abstract Ref Number = APCP842
DIABETIC KETOACIDOSIS IN A 21 MONTHS OLD GIRL
T Ade Prasetia,Rusdi Andid
Department of child health Faculty of Medicine Syiah Kuala University Dr Zainoel Abidin Hospital Banda Aceh Indonesia Department of Child Health, Faculty of Medicine Syiah Kuala UniversityDr Zainoel Abidin Hospital, Banda Aceh, Indonesia
Background : Diabetic ketoacidosis (DKA) at the onset of type 1 diabetes mellitus (T1DM) is more common in younger children (aged <2 years). The incidence of DKA in children diagnosed with T1DM is about 1-10% per patient per year. The risk of DKA in this group increases in children with poor metabolic control, previous DKA history, children who did not use insulin, adolescent girls or peripubertals, children with eating disorders, low socioeconomic, and children from families who did not have health insurance.
Case Presentation Summary : A 21 months old girl was admitted to emergency department of Zainoel Abidin Hospital, with a one day history of dyspneu and altered mental status. She had poor appetite, weight loss and frequent urination since a week ago. No family history of diabetes mellitus. On physical examination found a heart rate of 130/minute, respiratory rate of 48/minute with kussmaul breathing, temperature of 36,8 C, weight of 9 kg, normal capillary return and warm extremities. Laboratory investigation showed random blood glucose 397 mg/dL, ketonuria +4, and acidosis (pH: 6,974 mmHg, HCO3-: 3,3 mmol/L), confirming severe DKA. Leukocytes 39,2.103/mm3, serum levels of ureum and creatinine were normal. Na, K, Cl values were normal. Hb-A1c 10,5%. C-Peptide <0,1 ng/ml, confirming T1DM. Treatment: Resuscitation: airway, breathing, circulation, fluid replacement. Insulin therapy: 0,05 Unit/kg/hour, after starting fluid replacement therapy with monitoring blood glucose. Antibiotic injection. Subcutaneous insulin injection started after blood glucose stable and after patient start eating. She was discharged on the 13th day and continued insulin at home.
Learning Points/Discussion : Optimal management of the patient has achieved the best clinical outcomes. At this early age, it is important to arm the parent with the necessary information as concerns feeding, insulin treatment and blood glucose monitoring.
Keywords: Diabetic ketoacidosis Type 1 diabetes mellitus younger children