Diabetes Keto-acidosis in Children: A Report of Two Cases and Literature Review

Abstract

Aims: To present features of two cases of diabetes keto-acidosis observed in the Nouveau Village de Pédiatrie, Democratic Republic of Congo (DRC), between 2014 and 2018. Cases Presentation: The first case was a male patient, 13 years-old, who arrived with fever, vomiting, polyuria, unconsciousness, respiratory distress and coma. His fasting plasma glucose was 570 mg/dl. Urea nitrogen 56,4 mg/dl; Creatinine 2,1 mg/dl. C reactive protein was 27 mg/l. The treatment of diabetes ketoacidosis (DKA) was based on insulin, fluids and antibiotics. Despite glycemic normalization, he died with cerebral edema and sepsis. The second case was a female child of 6 years, received with fever, polydipsia, asthenia, polyuria, a familial history of diabetes. Random plasma glucose was 500 mg/dl and C reactive protein 10 mg/l. Despite insulin and antibiotics, her clinical state worsened by a pyelonephritis and pulmonary edema and, probably tuberculosis. She also died. Conclusion: Diabetes mellitus type 1 in children, complicated with DKA and sepsis, have worse prognosis. More children death would be avoidable by correct global treatment including insulin and hydro-electrolytic balance to prevent cerebral or pulmonary edema. Children with tuberculosis should realize routine screening for diabetes mellitus and inversely.