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

CASE REPORT

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).


Abstract

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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