Neonatal Diabetes Mellitus Accompanied by Diabetic Ketoacidosis and Mimicking Neonatal Sepsis: A Case Report

Abstract

Neonatal diabetes mellitus (DM) develops within the first six weeks of life with basic findings including dehydration, hyperglycaemia, and mild or no ketonemia/ketonuria. It can be either transient or permanent. Here, we report a case of a one−month−old infant with permanent neonatal diabetes, due to pancreatic hypoplasia, accompanied by diabetic ketoacidosis (DKA). The hyperglycaemia and ketoacidosis resolved by the 14th hour of treatment, consisting of IV insulin and rehydration. Subsequently, insulin treatment was continued with neutral protamine hagedorn (NPH) insulin. Breastfeeding was started and was continued at intervals of three hours. Following initiation of breastfeeding, the stools became watery, loose, yellow−green in color, and frequent (8−10 times a day). They contained no blood or mucus. Replacement of pancreatic enzymes resulted in decreased stool frequency. Neonatal DM due to pancreatic hypoplasia and associated with DKA may mimic sepsis and should be kept in mind in all newborns who present with fever, dehydration, and weight loss.Conflict of interest:None declared.

Successful sulfonylurea treatment of a neonate with neonatal diabetes mellitus due to a novel missense mutation, p.P1199L, in the ABCC8 gene

“…8 Several reviews were reported that ketonuria is usually mild or absent; however, DKA may develop when the diagnosis is delayed in NDM. 8,9 Our patient was misdiagnosed as having pneumonia in another hospital. We think that the cause of DKA in our case was due to delayed diagnosis or late admission to the emergency unit.…”

Neonatal diabetes mellitus due to a novel mutation in the GATA6 gene accompanying renal dysfunction: A case report

“…It is a rare condition with a reported incidence of approximately 1.43–1.96 in 100.000 infants [Rubio‐Cabezas et al, ]. Patients with NDM usually present with low birth weight and symptomatic hyperglycemia and rarely with ketoacidosis [Abaci et al, ; Rubio‐Cabezas et al, ]. Permanent NDM arising from pancreas agenesis or hypoplasia is very rare [Pos and Dimroth, ; Ashraf et al, ; Chen et al, ].…”

“…Patients with NDM usually present with intrauterine growth retardation, hyperglycemia, and failure to thrive and occasionally with diabetic ketoacidosis [Abaci et al, ]. This case report describes the phenotype of a patient with NDM due to pancreas agenesis.…”

Neonatal diabetes mellitus: current perspective

“…It can occur as early as 3 days of age and has been reported as the presenting symptom in multiple cohort studies and case reports. [17][18][19][20][21] IUGR is seen in .95% of TNDM patients, typically developing in the third trimester, such that the birth weight is typically 1.5-2.5 kg. 6 In fact, low birth weight can be regarded as a bioassay for in utero insulin secretion since insulin's role as growth factor is an important component of fetal growth.…”

“…Neonates with diabetes mellitus can present with significant hyperglycemia, electrolyte disturbance, dehydration, and ketoacidosis. 18 The initial management includes fluid resuscitation with isotonic electrolyte solutions, to treat the dehydration that results from osmotic diuresis. The appropriate fluid therapy is calculated on an individual basis and administered slowly over a period of 24-48 hours to avoid cerebral edema that can result from a rapid correction.…”