Diabetic ketoacidosis with acute kidney injury in prepubertal children: a report on two cases

Abstract

Type 1 diabetes mellitus is a result of autoimmune damage, in which environmental factors are thought to trigger the autoimmune destruction of pancreatic ß-cells.1,2 Worldwide, an estimated 65,000 children under 15 years of age develop type 1 diabetes mellitus each year.3 Approximately 30% of children who present with newly-diagnosed type 1 diabetes have diabetic ketoacidosis (DKA).4 Himawan et al. reported a DKA prevalence of43.6% in girls.5 The long-term effects of diabetes mellitus include retinopathy, chronic kidney disease (nephropathy), neuropathy, and dyslipidemia.2

Mild and severe diabetic ketoacidosis in children: a report of two cases

“…The severity of DKA is categorized by the degree of acidosis: mild DKA (pH <7.3 and/or HCO 3 <15 mmol/L), moderate DKA (pH <7.2 and/or HCO 3 <10 mmol/L), and severe DKA (pH <7.1 with or without HCO 3 <5 mmol/L). 2,3 In general, DKA may be unidentified, delayed, or misdiagnosed due to several factors, including lack of health care facilities in remote areas, subtle clinical presentations, unawareness of the symptoms, the patients avoiding medical assessment for fear of dreadful diagnosis, financial constraints, and regulations governing access to health care.…”

“…4 D i a b e t i c ke t o a c i d o s i s c a n i n d u c e a vicious life-threatening cycle of hyperglycemia, hyperketonemia, osmotic diuresis, severe vomiting, dehydration, loss of electrolytes, greater stress hormone production, and, thus, more severe insulin resistance. 3 The most fatal complication is cerebral edema. 1 Early identification and proper treatment of DKA are compulsory to prevent morbidity and mortality.…”

Mild and severe diabetic ketoacidosis in children: a report of two cases

“…The severity of DKA is categorized by the degree of acidosis: mild DKA (pH <7.3 and/or HCO 3 <15 mmol/L), moderate DKA (pH <7.2 and/or HCO 3 <10 mmol/L), and severe DKA (pH <7.1 with or without HCO 3 <5 mmol/L). 2,3 In general, DKA may be unidentified, delayed, or misdiagnosed due to several factors, including lack of health care facilities in remote areas, subtle clinical presentations, unawareness of the symptoms, the patients avoiding medical assessment for fear of dreadful diagnosis, financial constraints, and regulations governing access to health care.…”

“…4 D i a b e t i c ke t o a c i d o s i s c a n i n d u c e a vicious life-threatening cycle of hyperglycemia, hyperketonemia, osmotic diuresis, severe vomiting, dehydration, loss of electrolytes, greater stress hormone production, and, thus, more severe insulin resistance. 3 The most fatal complication is cerebral edema. 1 Early identification and proper treatment of DKA are compulsory to prevent morbidity and mortality.…”