Introduction: Neuropathy, as a complication of type 1 diabetes (T1D), is a heterogeneous group with chronic polyneuropathy being the most frequent form. Acute mononeuropathy is rare and its pathophysiology has not been elucidated.
Purpose: To describe acute mononeuropathy during the course of severe ketoacidosis in an 8-year-old girl diagnosed with T1D.
Case report: An 8-year old girl was admitted to the Emergency Department because of respiratory distress. She also complained for fatigue and drowsiness over the last two days. Physical examination revealed severe dehydration, Kussmaul respiration and ketotic breath. She was diagnosed with T1D based on hyperglycemia (Dextrostix 462 mg/dl) and severe ketoacidosis (pH 7.09, HCO3- 1.7 mmol/l). Furthermore, low insulin and C-peptide levels and positive glutamic acid decarboxylase (GAD) autoantibodies confirmed the diagnosis. The patient was treated with aggressive intravenous infusion of fluids and insulin according to international guidelines. Due to clinical and biochemical deterioration, she was tranferred to the Pediatric Intensive Care Unit (PICU). Diabetic ketoacidosis (DKA) was managed successfully and she was discharged to our department after four days. Subsequently, the patient started multiple daily injection of insulin and diabetes education. On the seventh day of her hospitilization, foot drop of right foot with loss of sensation in the dorsal surface, mild edema and redness were observed. After excluding osteomyelitis and thrombophlebitis, cellulitis was treated successfully with intravenous antibiotics. Further evaluation of foot drop with electrophysiological study revealed reduced conduction velocities indicative of severe axonal damage of right sciatic nerve and mild axonal damage of right femoral nerve. Otherwise, cyanocobalamin, folic acid, thyroid stimulating hormone (TSH) and free T4 levels were within normal ranges. Patient was advised physiotherapy and B6 and B12 vitamins and magnesium were prescribed. Four months later, she has no signs of clinical improvement.
Conclusion: Acute mononeuropathy as a complication of DKA is extremely rare in pediatric population and only a few cases have been described. The pathogenesis of this complication is still unknown.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology