Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 Jan 4;37(2):170-173.
doi: 10.1515/jpem-2023-0412. Print 2024 Feb 26.

From neglect to peril: diabetic ketoacidosis unleashing colonic necrosis and perforation in an adolescent girl with type 1 diabetes mellitus

Mritunjay Kumar  1 , Rini Dixit  1 , Rohit Kapoor  2 , Sunita Singh  2
Affiliations
Case Reports

From neglect to peril: diabetic ketoacidosis unleashing colonic necrosis and perforation in an adolescent girl with type 1 diabetes mellitus

Mritunjay Kumar et al. J Pediatr Endocrinol Metab. .

Abstract

Objectives: Abdominal pain is a common presentation in patients of diabetic ketoacidosis (DKA). However, this pain generally resolves with resolution of dehydration and acidosis. Persistence of abdominal pain even after resolution of ketosis and acidosis should warrant careful reassessment to find evidence of sepsis and concomitant abdominal pathology.

Case presentation: We report a rare case of type 1 diabetes mellitus in a 15 year old girl diagnosed 6 months ago who presented with mild DKA (pH 7.24, HCO3 - 13.5 mmol/L). Her hospital course was extremely stormy and despite best of our efforts she succumbed due to colonic ischemia and perforation peritonitis.

Conclusions: A high index of suspicion for gut ischemia or perforation should be kept if DKA is associated with septic shock and there is suboptimal response to standard treatment. Mesenteric ischemia can occur in pediatric patients even with mild DKA having very poor diabetes control.

Keywords: colonic necrosis; diabetic ketoacidosis; insulindependent diabetes mellitus (IDDM); perforation peritonitis.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

References

    1. DiMeglio, LA, Chaet, MS, Quigley, CA, Grosfeld, JL. Massive ischemic intestinal necrosis at the onset of diabetes mellitus with ketoacidosis in a three-year-old girl. J Pediatr Surg 2003;38:1537–9. https://doi.org/10.1016/s0022-3468(03)00510-4 . - DOI
    1. Bialo, SR, Agrawal, S, Boney, CM, Quintos, JB. Rare complications of pediatric diabetic ketoacidosis. World J Diabetes 2015;6:167–74. https://doi.org/10.4239/wjd.v6.i1.167 . - DOI
    1. Mansouri, F. Toxic megacolon with colonic ischemia masquerading as diabetic ketoacidosis: a case report. Saudi J Med Pharm Sci 2020;6:58–63. https://doi.org/10.36348/sjmps.2020.v06i01.010 . - DOI
    1. Frontino, G, Di Tonno, R, Castorani, V, Rigamonti, A, Morotti, E, Sandullo, F, et al.. Non-occlusive mesenteric ischemia in children with diabetic ketoacidosis: case report and review of literature. Front Endocrinol (Lausanne). 2022;13:900325. https://doi.org/10.3389/fendo.2022.900325 . - DOI
    1. Chan-Cua, S, Jones, KL, Lynch, FP, Freidenberg, GR. Necrosis of the ileum in a diabetic adolescent. J Pediatr Surg 1992;27:1236–8. https://doi.org/10.1016/0022-3468(92)90798-c . - DOI

Publication types

LinkOut - more resources