Uncommon presentation of common problem: pneumomediastinum in a child with diabetic ketoacidosis

Abstract

A 12-year-old girl, a known patient with type 1 diabetes mellitus, presented to our paediatric assessment unit with short history of vomiting. She was tachycardic, tachypnoeic and normotensive (117/71) on admission. Her blood sugar was high (26.7 mmol/L) with raised blood ketones and her venous blood gas showed metabolic acidosis with high base deficit confirming DKA. HbA1C was very high (99 mmol/mol). The management of DKA was initiated using the Southwest regional paediatric DKA protocol. Due to significant respiratory distress she underwent a chest radiograph, which revealed pneumomediastinum with no pneumothorax (figure 1). Clinical examination showed no evidence of subcutaneous emphysema and her breathing improved after correction of acidosis. The patient was observed closely and was kept nil by mouth. Repeat chest radiograph after 8 hours (figure 2) showed spontaneous resolution of mediastinal emphysema.