Abstract Ref Number = APCP857
Subarachnoid Haemorrhage as A Severe Complication of Newly Diagnosed Diabetic Ketoacidosis in Female Adolescence
Aulia Rahman,Faisal Bukkar,Novina Andriana
Department of Child Health Universitas Padjadjaran
Background : Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus (DM) that results from severe insulin deficiency and occurs primarily in type 1 diabetes mellitus (T1DM). The level alertness of primary care doctors and knowledge on DM play a role to prevent severe complication of DKA.
Case Presentation Summary : A 13 year-old girl was brought to emergency department in Dr. Hasan Sadikin General Hospital with decreased in consciousness, typical Kussmaul breathing, nausea, vomiting, and then complained an abdominal discomfort. Upon arrival, she was poor capillary return, cold fingers and seizure. The patient often felt thirsty and hungry while urinating more frequently 2 months before admitted to the hospital. Five days before arrival, he suffered a low grade fever, fatigue, loss of appetite, headache, and pain in right ear. From physical examination revealed that his blood pressure was 150/100 mmHg, nasogastric tube fluids appeared brownish black in colour. Blood glucose showed a result of 596 mg/dl. Quantitative CRP was 1.78 mg/dl, increase in potassium ion. Urinalysis showed glucosuria, proteinuria, and ketonuria. Blood gas analysis revealed a very low pH and bicarbonate accompanied with low pCO2 and high pO2. From CT scan, it was found that there was a subarachnoid haemorrhage filling the posterior interhemispheric fissure. The patient was then diagnosed with hypovolemic shock caused by diabetic ketoacidosis due to T1DM with status epilepticus caused by subarachnoid haemorrhage with diabetic nephropathy and upper gastrointestinal haemorrhage. The patient was resuscitated with iv fluid as soon as possible, followed by insulin, antibiotics, phenytoin. After administration of manitol for treatment high intracranial pressure. Patient showed a good improvement.
Learning Points/Discussion : DKA can results in many complications such as cerebral edema and stroke. Therefore, early recognition and immediate treatment may improve the potentially poor outcome.
Keywords: Subarachnoid haemorrhage Diabetic ketoacidosis Diabetes mellitus type 1