Recurrent Diabetic Ketoacidosis in Adolescents with Type 1 Diabetes Mellitus
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Abstract
Introduction: Diabetic ketoacidosis (DKA) is one of the serious complications that is often found in pediatric cases of type 1 diabetes mellitus (DM). Diabetic ketoacidosis mostly occurs in patients with low glycemic control. Currently, many studies are assessing risk factors for recurrent ketoacidosis, including young age, male gender, patients with comorbidities (psychiatric diseases, alcohol or substance abuse, other chronic diseases), and patients with socioeconomic factors. The incidence of recurrent diabetic ketoacidosis in children and adolescents is becoming more frequent. Risk factors that often trigger the incidence of diabetic ketoacidosis are important to understand to reduce the incidence of recurrent DKA.
Case Presentation: This study reported a 17-year-old adolescent patient with a history of type 1 diabetes mellitus who had recurrent diabetic ketoacidosis. Patients come with complaints of nausea and vomiting, accompanied by a feeling of weakness. The results of the blood glucose test were 565 mg/dL. In urinalysis, a reduction of glucose was obtained (+3), and ketonuria with urinary ketones was obtained with a result of +3. A blood gas analysis showed a blood pH of 7,367 mmHg with HCO3 of 16.6 mmol/L and PCO2 of 28.6 mmHg. The initial management of the patient was given a loading of 0.9% NaCl fluid as much as 500 cc/hour for 2 hours, then 0.9% NaCl fluid as much as 500 cc mixed with KCL 10 meq at a rate of 75 ml/hour. The patient was also given an insulin drip to correct blood glucose levels in the form of 5 IU of insulin diluted with 0.9% NaCl, as much as 50 cc. During treatment, the patient's condition tends to stabilize, and the patient is discharged from the hospital by continuing with routine treatment with subcutaneous insulin.
Conclusion: Diabetic ketoacidosis is one of the complications with high morbidity and mortality, especially in patients with type 1 diabetes mellitus. There are several risk factors associated with recurrent DKA in patients. Known risk factors for DKA allow health workers to prevent the occurrence of a recurrence of DKA.
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References
I. Raghupathy P. Diabetic ketoacidosis in children and adolescents. Indian J Endocrinol Metab. 2015 Apr;19(Suppl 1):S55-7. Doi: 10.4103/2230-8210.155403. PMID: 25941653; PMCID: PMC4413392.
II. Ndu, I. K., Chikani, U. N., Edelu, B. O., Nduagubam, O. C., Bisi-Onyemaechi, A. I., Ekwochi, U., Asinobi, I. N., & Ekwochi, U. (2021). Prevalence and Pattern of Diabetic Ketoacidosis among Children an Enugu, Southeast Nigeria: a 10 Year Retrospective Study. Tropical Health and Medical Research, 3(1), 36–43. https://doi.org/10.35916/thmr.v3i1.21
III. Kostopoulou E, Sinopidis X, Fouzas S, Gkentzi D, Dassios T, Roupakias S, Dimitriou G. Diabetic Ketoacidosis in Children and Adolescents; Diagnostic and Therapeutic Pitfalls. Diagnostics (Basel). 2023 Aug 4; 13(15):2602.
a. Doi: 10.3390/diagnostics13152602. PMID: 37568965; PMCID: PMC10416834.
IV. Sukamto. (2022). Penanganan Ketoasidosis Diabetik pada Anak. Cermin Dunia Kedokteran, 49(9), 527–531. https://doi.org/10.55175/cdk.v49i9.301
V. Tzimenatos, L., & Nigrovic, L. E. (2021). Managing Diabetic Ketoacidosis in Children. Annals of Emergency Medicine, 78(3), 340–345. https://doi.org/10.1016/j.annemergmed.2021.02.028
VI. Faisal, Mulyadi, dkk. (2020). Hubungan Derajat Ketoasidosis Diabetik dengan Kadar Kalium pada Pasien Anak di Rumah Sakit Dr. Hasan Sadikin Periode Tahun 2014-2019. Sari Pediatri 2020; 22(2):71-5. DOI:
http://dx.doi.org/10.14238/sp22.2.2020.71-5
VII. Wolfsdorf JI, Allgrove J, Craig ME, Edge J, Glaser N, dkk. ISPAD Clinical Practice Consensus Guidelines 2014 Compendium: A Consensus Statement from the International Society for Pediatric and Adolescent Diabetes: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatric Diabetes.2014;15:154-79
VIII. Brandstaetter, E., Bartal, C., Sagy, I., Jotkowitz, A., & Barski, L. (2019). Recurrent diabetic ketoacidosis. Archives of Endocrinology and Metabolism. doi:10.20945/2359-3997000000158
IX. Castellanos, L., Tuffaha, M., Koren, D., & Levitsky, L. L. (2020). Management of Diabetic Ketoacidosis in Children and Adolescents with Type 1 Diabetes Mellitus. Pediatric Drugs, 22(4), 357–367. doi:10.1007/s40272-020-00397-0
X. Rosenbloom, A. L. (2010). The management of diabetic ketoacidosis in children. Diabetes Therapy, 1(2), 103–120. doi:10.1007/s13300-010-0008-2
XI. Nusantara, A. F., Kusyairi, A., Salam, A. Y., & Sulistiana, E. (2023). Diabetic Ketoacidosis In Children With Type 1 Diabetes: Behavioral Patterns And Clinical Manifestation As Predictive Factors. Journal of Applied Nursing and Health, 5(2), 151–160. https://doi.org/10.55018/janh.v5i2.131
XII. Dhatariya, K. K., Glaser, N. S., Codner, E., & Umpierrez, G. E. (2020). Diabetic ketoacidosis. Nature Reviews Disease Primers, 6(1). doi:10.1038/s41572-020-0165-1
XIII. Rochmah, N., Faizi, M., & Harjantien, N. (2015). Diabetic ketoacidosis in children: an 11-year retrospective in Surabaya, Indonesia. Paediatrica Indonesiana, 55(1), 40. doi:10.14238/pi55.1.2015.40-3
XIV. Wolfsdorf JI, Glaser N, Agus M, Fritsch M, HanasR, Rewers A, et al. ISPAD clinical practice consensus guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes 2018; 19:155-77.
XV. Rugg-Gunn CEM, Deakin M, Hawcutt DB. Update and harmonisation of guidance for the management of diabetic ketoacidosis in children and young people in the UK. BMJ Paediatr Open 2021; 5:e001079. doi:10.1136/bmjpo-2021-001079
XVI. Steenkamp DW, Alexanian SM, McDonnell ME. Adult hyperglycemic crisis: a review and perspective. Curr Diab Rep. 2013;13(1):130-7
XVII. Liu CC, Chen KR, Chen HF, Huang HL, KO MC, Li CY. Trends in hospitalization for diabetic ketoacidosis in diabetic patients in Taiwan: analysis of national claims data, 1997-2005. J Formos Med Assoc. 2010; 109(10):725-34.
XVIII. Bradford AL, Crider CC, Xu X, Naqvi SH. Predictors of recurrent hospital admission for patients presenting with diabetic ketoacidosis and hyperglycemic hyperosmolar state. J Clin Med Res. 2017;9(1):35-9
XIX. Isidro ML, Jorge S. Recreational drug abuse in patients hospitalized for diabetic ketosis or diabetic ketoacidosis. Acta Diabetol. 2013;50(2):183-7
XX. Cooper H, Tekiteki A, Khanolkar M, Braatvedt. Risk factors for recurrent readmissions with diabetic ketoacidosis: a case-control observational study. Diabet Med. 2016; 33(4):523-8.