Introduction: Diabetic ketoacidosis (DKA) in children is related with high risk of severe complications in the central nervous system such as cerebral oedema, hematoma and thrombosis.
The occurrence of cerebral oedema in children with DKA is around 1: 100 and is higher in young children with severe acidosis and in whom DKA is the first manifestation of the disease.
Case Report: 12-month-old patient diagnosed with diabetes was admitted to the Paediatric Diabetes Department after hospitalization in the Paediatric Intensive Care Unit due to coma caused by severe diabetes ketoacidosis.
Before admission to hospital baby's parents noticed failure to thrive, polyuria and polydipsia, 2 days before admission antibiotic treatment of pharyngitis was prescribed. On the day of admission, patient's parents noticed that child had abnormal breathing and did not response normally, therefore they went to hospital.
In laboratory tests severe metabolic acidosis and hyperglycemia were found and intravenous therapy with fluids and insulin was started. After 15 hours of treatment patient had an episode of bradycardia which was resolved after administration of mannitol. After 2 days child was discharged from PICU and transferred to the Diabetes Department.
At the admission to Diabetes Department patient was conscious and stable, but not very active. Due to severe acidosis and long-lasting disturbances of consciousness, brain MRI was performed, and areas of increased signal in PD, T2 dependent images were detected in the cerebellum and both cerebellar hemispheres, which did not strengthen after contrast and showed diffusion limitations, which could be a result of acute ischemic and hypoxic changes. In the following days, the child's condition improved, he was more active and according to parents he was behaving as before DKA. Stable glucose levels were achieved by treatment with personal insulin pump. Physiotherapy was advised and his psychomotor development in the second and third year of life was going well.
One year after DKA, brain MR was performed again, in which there were malacia lesions in the cerebellar hemispheres seen, the rest of brain structures were without any visible changes. Patient remains under diabetic and neurological care. Diabetes control is good and there are no concerns about his development.
Conclusions: In young children with type 1 diabetes fast diagnosis of diabetes is crucial as the first manifestation of the disease may be severe metabolic acidosis with high risk of complications. Children with severe acidosis require intensive treatment of DKA due to possible complications.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology