Challenges in the management of concurrent diabetic ketoacidosis and Dengue hemorrhagic fever in a child

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.

Keywords

• diabetic ketoacidosis, insulin, polyuria, dengue