Severe diabetic ketoacidosis complicated with severe dyslipidemia, cerebral edema and acute kidney injury in a pediatric girl with type 1 diabetes mellitus: a case study
DOI:
https://doi.org/10.18203/2349-3291.ijcp20231863Keywords:
Diabetic ketoacidosis, Renal failure, Severe dyslipidemiaAbstract
Diabetic ketoacidosis (DKA) is a life-threatening acute metabolic complication occurring in patients with type 1 diabetes, due to an insulin deficiency. Moderate hypertriglyceridemia is commonly observed in DKA but severe hypertriglyceridemia with a triglyceride level exceeding 10 g/l is very rarely reported. Acute kidney injury (AKI) is a serious condition which still carries a mortality of around 50%. Cerebral edema is a devastating complication of DKA which is leading cause of diabetes-related death in the pediatric population. Newly diagnosed diabetes, younger age, first episode of DKA, severity of DKA at presentation, and administration of bicarbonate are predictive of cerebral edema in DKA. We present a case of 8-year-old girl who presented with severe DKA, whose clinical course was complicated by renal failure, severe dyslipidemia and cerebral edema.
References
Chiasson JL, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ekoé JMet al. Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state. CMAJ. 2003;168(7):859-66.
Kitabchi AE, Wall BM. Diabetic ketoacidosis. Med Clin North Am. 1995;79(1):9-37.
Rose KL, Watson AJ, Drysdale TA, Cepinskas G, Chan M, Rupar CA, et al. Simulated diabetic ketoacidosis therapy in vitro elicits brain cell swelling via sodium-hydrogen exchange and anion transport. Am J Physiol Endocrinol Metab. 2015;309(4):E370-9.
Lawrence SE, Cummings EA, Gaboury I, Daneman D. Population-based study of incidence and risk factors for cerebral edema in pediatric diabetic ketoacidosis. J Pediatr. 2005;146(5):688-92.
Nyamugunduru G, Roper H. A difficult case. Childhood onset insulin dependent diabetes presenting with severe hyperlipidaemia. BMJ. 1997;314(7073):62-5.
Corwell B, Knight B, Olivieri L, Willis GC. Current diagnosis and treatment of hyperglycemic emergencies. Emerg Med Clin North Am. 2014;32(2):437-52.
Saengkaew T, Sahakitrungruang T, Wacharasindhu S, Supornsilchai V. DKA with Severe Hypertriglyceridemia and Cerebral Edema in an Adolescent Boy: A Case Study and Review of the Literature. Case Rep Endocrinol. 2016;2016:7515721.
Fick T, Jack J, Pyle-Eilola AL, Henry RK. Severe hypertriglyceridemia at new onset type 1 diabetes mellitus. J Pediatr Endocrinol Metab. 2017;30(8):893-7.
Keefe C, Lawson S. ApoE isoform leading to hypertriglyceridemia in new onset type 1 diabetes. Clin Case Rep. 2018;6(7):1287-90.
Yuen N, Anderson SE, Glaser N, Tancredi DJ, O'Donnell ME. Cerebral blood flow and cerebral edema in rats with diabetic ketoacidosis. Diabetes. 2008;57(10):2588-94.
