Diabetic ketoacidosis in a pediatric patient with type 1 diabetes mellitus and the impact of insulin therapy discontinuation: a case report

Abstract

Introduction: Diabetic ketoacidosis is a serious acute complication of diabetes mellitus, characterized by hyperglycemia (blood glucose > 200 mg/dL), metabolic acidosis (venous pH < 7.3 and/or bicarbonate < 15 mEq/L), ketonemia, and ketonuria. It is triggered by infections, insulin administration failures, or progressive pancreatic beta-cell failure. Objective: To present a case of diabetic ketoacidosis in a ten-year-old patient diagnosed with type 1 diabetes mellitus three years ago, with poor treatment adherence. Case description: A ten-year-old school-aged child, diagnosed with type 1 diabetes mellitus at age seven, had not used NPH insulin for one week and regular insulin for one day. The patient developed vomiting associated with nausea, dizziness, and pain in both upper and lower limbs. The diagnosis was moderate diabetic ketoacidosis, the third episode since the diabetes diagnosis. Discussion: The diagnosis of diabetic ketoacidosis relies not only on blood glucose but also on pH, ketonemia, and ketonuria. Classification depends on pH and clinical presentation. The pathophysiology includes insulinopenia, hyperglycemia, dehydration, ketone body production, and depletion of the bicarbonate buffer system. Clinical manifestations include polyphagia, polydipsia, polyuria, vomiting, abdominal pain, and dehydration. Treatment involves insulin therapy and hydroelectrolytic replacement, with a focus on fluid resuscitation and potassium supplementation. In this case, the patient presented vomiting, dizziness, and paresthesia in the lower limbs, with a blood glucose level of 864 mg/dL and arterial pH of 7.16.