Ketoacidosis Onset of Diabetes on a Patient with Normal C-Peptide Value

Abstract

Background:Diabetic ketoacidosis is an acute major life-threatening complication of diabetes, characterized by hyperglycemia, ketoacidosis and ketonuria, which can be life threatening if it is not promptly recognized and treated. This occurs mainly in patients with type 1 diabetes, but stressors like trauma and infection can increase the risk of ketoacidosis in other forms of diabetes such as type 2 diabetes. Type 2 diabetes mellitus is a complex metabolic disorder of heterogeneous etiology with behavioral, social, and environmental risk factors that unmask the effects of genetic susceptibility. Recent studies indicate an increasing prevalence of type 2 diabetes mellitus in children and adolescents around the world in all ethnicities. C-peptide is a useful and widely used method of assessing pancreatic beta cell function given his structure: part of proinsulin which is cleaved prior to co-secretion with insulin from pancreatic beta cells. This is used as a tool in the differentiation of type 1 diabetes from type 2 but also other types of diabetes. We present a 12-year-old previously healthy male who was hospitalized in our clinic for polydipsia, polyuria, weight loss and emesis, with symptom onset 10 days prior to admission. On the admission day, he presented to the emergency room for progressively increasing somnolence, apathy, decreased muscle tone and urinary incontinence. Physical examination was significant for grade I obesity [height 168 cm and weight 90 kg, yielding a body index mass (BMI) of 31.78 kg/m2, percentile >97%], lethargy, slurred speech, high blood pressure (145/90 mmHg), tachycardia (145 beats per minute) and acanthosis nigricans. Considering his physical examination, laboratory tests and clinical evolution, he was diagnosed with type 2 diabetes mellitus complicated with hyperosmolar hyperglycemic state and diabetic ketoacidosis. Diabetic ketoacidosis should be considered in the differential diagnosis of metabolic decompensation in all types of diabetes. Although type 2 diabetes mellitus seems to be still rare in childhood and adolescence, prevention and treatment of type 2 diabetes mellitus should become public awareness and public health intervention programs. The particularity of this case was the unusual onset of diabetes mellitus type 2 in a male child with metabolic syndrome.