OBJECTIVE: Diabetic ketoacidosis (DKA) is an acute and life-threatening complication of Diabetes Mellitus (DM). As a presenting manifestation, DKA is more typically associated with type 1 DM than type 2 DM. Previous studies stated that only approximately 5% of children with type 2 DM have DKA as presenting manifestation. Type 2 DM has been deemed rare in children and adolescents until mid-1990s whereby there was an increased prevalence of type 2 DM in children. With increased prevalence of obesity, type 2 DM is now an emerging challenge in pediatric practice.
CASE: A 13 years-old boy presented to the Emergency Room (ER) with primary complaint of epigastric pain followed by nausea and vomiting. The patient is obese and has a history of polyphagia, polydipsia, and polyuria since 2 weeks prior. The patient’s mother has type 2 DM. The physical findings showed Kussmaul breathing and dehydration. Laboratory findings upon admission revealed acidosis (pH: 7.14, bicarbonate: 5.3 mg/dL), hyperglycemia (435.0 mg/dL) and ketonemia (4.3 mg/dL). Urinalysis revealed proteinuria, ketonuria, and glucosuria. The patient was treated as moderate DKA. DM type I was suspected due to epidemiologic
consideration. However, DM type 2 was not dismissed. Blood C-peptide was normal, hence further therapy on patient was based on the suspicion of DM type 2. The patient was given metformin with basal insulin on the fourth day of admission and the patient showed improved plasma glucose profile.
CONCLUSION: Although DKA as presenting manifestation is typically associated with type 1 DM which is more frequently found in pediatric patients, the possibility of the patient having a type 2 DM should not be dismissed without further observation and laboratory confirmation. Risk factors that often associated with type 2 DM such as obesity and family history of type 2 DM should be considered when determining the diagnosis.