Abstract
Diabetic ketoacidosis (DKA) is more commonly seen in children with type 1 diabetes and acute acidosis is usually precipitated by infections, trauma and surgery. Rarely, ketoacidosis can be precipitated by dengue often leading to management challenges in achieving haemodynamic stability. Occurrence of both conditions together warrant meticulous monitoring of fluid balance and control of blood glucose levels to manage both conditions optimally. Both type1 and type 2 diabetes upsurge the release of pro-inflammatory cytokines by various mechanisms and intensify the risk of plasma leakage. As prevalence of diabetes is lower in children compared with adults, diabetic ketoacidosis presenting with dengue is rare in the paediatric age group. We report a 14-year-old diagnosed child with type1 Diabetes mellitus who presented with dengue fever and subsequently developed dengue haemorrhagic fever and diabetic ketoacidosis concurrently. Both conditions were successfully managed with appropriate use of intravenous fluids and insulin. He had a complicated course with secondary bacterial infection needing intravenous antibiotics for 14 days. Ultimately he was discharged with his routine regimen of insulin and follow up was arranged at the endocrinological clinic.
Highlights
Dengue is one of the most common tropical diseases in many countries including Sri Lanka
We report a 14year-old diagnosed child with type1 Diabetes mellitus who presented with dengue fever and subsequently developed dengue haemorrhagic fever and diabetic ketoacidosis concurrently
We report a child with poorly controlled type1diabetes in whom the management was complicated due to cooccurrence of diabetic ketoacidosis and dengue haemorrhagic fever
Summary
Dengue is one of the most common tropical diseases in many countries including Sri Lanka. He was managed as dengue fever with the targeted oral and intravenous fluids for initial 2 days following admission As he developed high fever, severe abdominal pain, and urine output started to increase (>2ml/kg/hour), he was transferred to intensive care unit (ICU) for further management. Acidosis normalized with the correction of fluids and blood glucose levels As he had high fever and high C-reactive protein, he was started on intravenous antibiotics while being treated at the intensive care unit. His blood glucose normalized with negative urinary ketones 72 hours after he was admitted to ICU at which point he was changed to subcutaneous insulin with oral food and fluids and transferred to ward for further management As he had continued fever and high inflammatory markers, he was treated with a 14-day course of intravenous antibiotics. His insulin dose was adjusted according to blood glucose level by the endocrinologist
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