Case Report
Volume 12 Issue 8 - 2020
An Unusual Presentation of a Child with Diabetic Ketoacidosis. Case Report
Amina Joarder1, Amal Alqassmi2*, Musa ALzahrani3 and Fahad AlRabeeah3
1Pediatric Neurology, King Saud Medical City, Children Hospital, Riyadh, Saudi Arabia
2Pediatric ICU Resident, King Saud Medical City, Riyadh, Saudi Arabia
3Pediatric Endocrinology, King Saud Medical, Riyadh, Saudi Arabia
*Corresponding Author: Amal Alqassmi, Pediatric ICU Resident, King Saud Medical City, Riyadh, Saudi Arabia.
Received: June 13, 2020; Published: July 25, 2020


Diabetic ketoacidosis is well known in paediatric patients with both newly diagnosed and established type 1 diabetes.

We are presenting the case of a rare neurological presentation. A three years old female presented to the Emergency room in KSMC (King Saud Medical City), Children’s hospital in Saudi Arabia with fever, rapid breathing, excessive urination and abdominal pain for two days, she had unrecordably high blood glucose with severe metabolic acidosis with a VBG reading as follows, pH 6.9, Bicarbonate 6.0, base excess -25, lactate 1.3 with wide anion gap. Urine had positive ketones 3 plus and glucose 4 plus.

 Based on the presentation and lab work up the diagnosis of DKA (diabetic ketoacidosis) was made and she was started on the DKA management protocol as per endocrinology unit protocol in KSMC hospital. She encountered three episodes of generalised tonic-clonic convulsion in the PICU the day od admission and after few of DKA management and showed clinical improvement of metabolic acidosis and her level of conscious improved, she had sudden decrease in her level of conscious with mild metabolic acidosis (ph: 7.1, Bicarbonate 10, we notice on neurological examination she was found to have quadriparesis, power 1/5 and absent reflex all upper and lower limb with the involvement of the respiratory muscles. She was treated after full work up including MRI brain and Spine with conduction study as suspected acute critical polyneuropathy, improved.

In conclusion, children presenting with DKA may develop fatal neurological sequelae like cerebral oedema, although this is rare. Critical illness polyneuropathy and Guillain-Barré syndrome should be considered as a differential in acute weakness with DKA patient with consideration of other possibilities; early management can improve the outcome of the patient.

Keywords: Diabetes Mellitus Type 1; DKA; Polyneuropathy; GBS


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Citation: Amal Alqassmi., et al. “An Unusual Presentation of a Child with Diabetic Ketoacidosis. Case Report”. EC Neurology 12.8 (2020): 169-174.

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