Case: A 14 year-old boy was found semiconscious by his mother following difficulty in sleeping overnight as he felt intermittently hot and cold. He had intentionally tried to lose weight (about 25 kg over 6 weeks). Presenting weight was 81 kg. Following prolonged resuscitation at home, GCS was 12 on arrival to hospital, 8 when intensive care team arrived. pH was <6.9 throughout. First venous glucose was 80 mmol/l (unrecordable on gas and glucometer), first plasma Sodium 119 mmol/l (corrected 141.3 mmol/l), calculated osmolality 338.2 mOsm/kg. Despite cautious resuscitation fluids and hydration volumes, slow reduction of hyperglycaemia (61.9 mmol/l after 6 hours), and close watch of sodium levels (corrected sodium at 6 hours 141.9 mmol/l), the child continued to deteriorate and died in the intensive care unit. Tabulated results will be presented and comparison of treatment of DKA and HHS.
Conclusion: There should be a maximum weight to be used in the DKA fluid calculator (although in this case a reduced weight was inputted due to the large volumes worked out on current weight). Post mortem results confirmed Type 1 Diabetes Mellitus. Family could find no evidence of any medication used to control his weight.
23 - 25 Nov 2016
British Society for Paediatric Endocrinology and Diabetes