Endocrine Abstracts

JOINT2929

Hamman’s syndrome, an uncommon complication of diabetic ketoacidosis (DKA), is characterized by spontaneous subcutaneous emphysema and pneumomediastinum. The pathophysiology of Hamman’s syndrome in the context of DKA is multifactorial, with increased intra-alveolar pressure due to Kussmaul respiration and recurrent vomiting being key contributors to alveolar rupture. This case report describes an 11-year-old female of Indian origin, newly diagnosed with type 1 diabetes mellitus (T1DM), presenting with severe DKA. Upon admission, the patient had a blood pH of 7. 11, bicarbonate levels of 5. 4 mmol/l, a partial pressure of carbon dioxide (pCO2) of 16. 5 mmHg and Glu: 405mg/dl. Her vital signs were the following: Blood pressure: 133/89mmHg, heart rate: 144bmp, respiratory rate: 50/min, temperature: 36, 7°C. Clinical symptoms included a 7-day history of polydipsia, polyuria, and weight loss (3 kg), along with acute onset of chest pain and shortness of breath for 1 hour prior to presentation. On examination, the patient demonstrated Kussmaul breathing and tachycardia. Initial management with intravenous fluids and insulin infusion was initiated at a local general hospital. Following stabilization, she was transferred to a tertiary pediatric center for further evaluation and care. Routine physical examination at the tertiary center revealed bilateral neck crepitus and a mediastinal crunch on auscultation, suggestive of Hamman’s syndrome. The diagnosis was confirmed with imaging, including chest X-ray and computed tomography (CT). During her hospital stay, the patient underwent continuous pediatric, cardiological, pulmonological, and endocrinological evaluations to ensure comprehensive management of both her acute condition and underlying comorbidities. Successful treatment of DKA led to complete resolution of her symptoms, and she was discharged with a structured follow-up plan. This case underscores the importance of recognizing Hamman’s syndrome as a potential complication of DKA in pediatric patients. Early identification and differentiation from more severe conditions, such as Boerhaave’s syndrome, are critical for ensuring optimal outcomes. Increased awareness and understanding of this rare syndrome can aid in prompt diagnosis and effective management, thereby improving patient care.