Endocrine Abstracts

Patient Z., 13 years old, transferres to the ICU with diagnosis: Diabetes mellitus newly diagnosed. Diabetic ketoacidotic coma II. Concomitant: Left-sided pneumonia.

Objective: Cussmaul’s breath, 36/minute. Pulse 128/min. BP 100/60 mm Hg. Glycemia 30.4 mmol/l, ketones in urine: ++++. CBC, urine, biochemical analysis of blood had not any special features. In the dynamics of the phenomenon of increasing respiratory failure and falling hemodynamics, the patient was intubated, pulmonary ventilation was started in the SIMV mode, inotropic support started. Lungs: left-sided upper-lobe large-focal pneumonia, Pseudomonas Aeruginosae was found in the sputum. The patient was admitted with extremely severe dehydration, disturbed microcirculation, including violation of renal blood flow, which was reflected in diuresis inadequate to glycemia. Infusion therapy was carried out under strict control of CVP and diuresis, however, CVP was negative during the first two days. The speed of infusion therapy was 15 ml/kg/h for the first 24 h, 11.4 ml/kg/h during the following 24 h, followed by a decrease to 7–8 ml/kg/h at the 3rd and 4th days, 6 ml/kg/h at the day 5. On the fourth day the introduction of fluids through the nasogastric tube, and on the 5th day feeding was started. The decrease in glycemia during the first day was down to 13 mmol/l, on day 2 - to 7.8 mmol/l. Ketonuria was eliminated by the 2nd day. Insulin infusion rate during the first day was 0.2 units/kg/h during the first 6 h, but as this dose was insufficient, it has been raised to 0.38 U/kg/hr during the 2nd day, 0.1 unit/kg/h for the first 12 h of the 3rd day, with gradual decrease during the next day to 0.07–0.06–0.04 units/kg/h. Long acting insulin was added on the 6th day of treatment. At the time of discharge, the daily dose of insulin was 13 units. Potassium solutions were administered according to international recommendations. The reasons for the development of a critical life-threatening condition in this patient are: late admission; late diagnostics; the presence of severe competing diseases - left-sided large-focal pneumonia, bilateral acute purulent otitis media; excessively high insulin requirements associated with puberty. Patient was checked out in 1 month for reabilitation and diabetes education.