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VOLUME 21 , ISSUE 9 ( 2017 ) > List of Articles


Diabetic ketoacidosis with extreme hypernatremia in a 4-year-old girl

Sheikh Minhaj Ahmed, Krishnakumar Shah, Uma Ali

Keywords : Deep vein thrombosis, diabetic ketoacidosis, extreme hypernatremia, skin blisters

Citation Information : Ahmed S M, Shah K, Ali U. Diabetic ketoacidosis with extreme hypernatremia in a 4-year-old girl. Indian J Crit Care Med 2017; 21 (9):610-612.

DOI: 10.4103/ijccm.IJCCM_226_17

License: CC BY-ND 3.0

Published Online: 01-12-2016

Copyright Statement:  Copyright © 2017; The Author(s).


A 4-year-old girl admitted with altered mental status, new-onset diabetes mellitus, and diabetic ketoacidosis (DKA) had a rapid rise in serum sodium from 158 mEq/L (corrected sodium 165 mEq/L) at the admission to 204 mEq/L within 18 hours of admission despite standard fluid and insulin therapy recommended for the treatment of DKA. During her illness, she developed arterial and deep vein thrombosis (DVT), bloodstream infection with Candida species, and extensive skin blistering and denudation. The child needed mechanical ventilation, insulin infusion, careful fluid titration to bring down the sodium gradually, and low-molecular weight heparin for her DVT. She had a prolonged Intensive Care Unit and hospital stay but recovered completely without any neurological sequelae.

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  1. Wolfsdorf J, Glaser N, Sperling MA; American Diabetes Association. Diabetic ketoacidosis in infants, children, and adolescents: A consensus statement from the American Diabetes Association. Diabetes Care 2006;29:1150-9.
  2. Frier BM, Steer CR, Baird JD, Bloomfield S. Misleading plasma electrolytes in diabetic children with severe hyperlipidaemia. Arch Dis Child 1980;55:771-5.
  3. Barsoum NR, Levine BS. Current prescriptions for the correction of hyponatraemia and hypernatraemia: Are they too simple? Nephrol Dial Transplant 2002;17:1176-80.
  4. McDonnell CM, Pedreira CC, Vadamalayan B, Cameron FJ, Werther GA. Diabetic ketoacidosis, hyperosmolarity and hypernatremia: Are high-carbohydrate drinks worsening initial presentation? Pediatr Diabetes 2005;6:90-4.
  5. Vanelli M, Chiari G, Ghizzoni L, Capuano C, Bonetti L, Costi G, et al. Ketoacidosis and hyperosmolarity as first symptoms of type 1 diabetes mellitus following ingestion of high-carbohydrate-containing fluids. J Pediatr Endocrinol Metab 1999;12:691-4.
  6. Bhowmick SK, Hundley OT, Rettig KR. Severe hypernatremia and hyperosmolality exacerbated by an herbal preparation in a patient with diabetic ketoacidosis. Clin Pediatr (Phila) 2007;46:831-4.
  7. Worly JM, Fortenberry JD, Hansen I, Chambliss CR, Stockwell J. Deep venous thrombosis in children with diabetic ketoacidosis and femoral central venous catheters. Pediatrics 2004;113(1 Pt 1):e57-60.
  8. Gutierrez JA, Bagatell R, Samson MP, Theodorou AA, Berg RA. Femoral central venous catheter-associated deep venous thrombosis in children with diabetic ketoacidosis. Crit Care Med 2003;31:80-3.
  9. van Amerongen RH, Moretta AC, Gaeta TJ. Severe hypernatremic dehydration and death in a breast-fed infant. Pediatr Emerg Care 2001;17:175-80.
  10. Gurkan A, Erkek N, Senel S. Localized bullous eruptions away from infusion site due to intravenous acyclovir administration in a child. Indian J Pharmacol 2012;44:126-8.
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