From neglect to peril: diabetic ketoacidosis unleashing colonic necrosis and perforation in an adolescent girl with type 1 diabetes mellitus
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Mritunjay Kumar
,
Rini Dixit
Abstract
Objectives
Abdominal pain is a common presentation in patients of diabetic ketoacidosis (DKA). However, this pain generally resolves with resolution of dehydration and acidosis. Persistence of abdominal pain even after resolution of ketosis and acidosis should warrant careful reassessment to find evidence of sepsis and concomitant abdominal pathology.
Case presentation
We report a rare case of type 1 diabetes mellitus in a 15 year old girl diagnosed 6 months ago who presented with mild DKA (pH 7.24, HCO3− 13.5 mmol/L). Her hospital course was extremely stormy and despite best of our efforts she succumbed due to colonic ischemia and perforation peritonitis.
Conclusions
A high index of suspicion for gut ischemia or perforation should be kept if DKA is associated with septic shock and there is suboptimal response to standard treatment. Mesenteric ischemia can occur in pediatric patients even with mild DKA having very poor diabetes control.
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Research ethics: Exempted from IEC.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Research funding: None declared.
References
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Articles in the same Issue
- Frontmatter
- Review
- Myoinositol or D-chiro-inositol for PCOS symptoms in adolescents: a narrative review
- Mini Review
- Effects of the COVID-19 pandemic on the incidence of central precocious puberty; a narrative review
- Original Articles
- Evaluation of the role of FTO (rs9939609) and MC4R (rs17782313) gene polymorphisms in type 1 diabetes and their relation to obesity
- Lack of association between month of birth and risk of developing type 1 diabetes in Brazil: a 40-year analysis
- Review on the screening of urine glucose for early diagnosis of type 2 diabetes mellitus in school children and adolescents with obesity in Hong Kong
- Effect of daily zinc supplementation for 12 weeks on serum thyroid auto-antibody levels in children and adolescents with autoimmune thyroiditis – a randomized controlled trial
- Correlation between serum vitamin D level and uterine volume in girls with idiopathic central precocious puberty
- Diagnostic model based on multiple factors for girls with central precocious puberty
- Validity and reliability of parent assessments of pubertal maturation among adolescent girls in Isfahan, Iran
- Newborn screening for primary carnitine deficiency using a second-tier genetic test
- Case Reports
- From neglect to peril: diabetic ketoacidosis unleashing colonic necrosis and perforation in an adolescent girl with type 1 diabetes mellitus
- Unusual onset of Graves’ disease associated with thymic hyperplasia in a 5-year-old girl with congenital bilateral clinical anophthalmia: diagnostic and therapeutic challenges
- Thyroid hormone resistance and large goiter mimicking infiltrative carcinoma in a pediatric patient
- Hereditary hypomagnesemia with secondary hypocalcemia caused by a novel mutation in TRPM6 gene
- Letter to the Editor
- Congenital hyperinsulinism patient with ABCC8 and KCNJ11 double heterozygous variants: a case report with 6 years follow-up
