ANION GAP NORMALIZATION IN MEDICAL WARDS

AN ADOLESCENT CASE OF NEW-ONSET TYPE 1 DIABETES WITH SEVERE KETOACIDOSIS

Abstract

CASE
Most children with severe diabetic ketoacidosis without alterations in mental status can be managed safely in the medical unit (JPEM2022;36:174). A 15-year-old female was brought to the emergency department of a tertiary center in Beijing with a chief complaint of abdominal pain and vomiting for one day. Arterial blood gas showed pH 6.988, HCO3- 2.8mmol/L, BE -29.8, pCO2 12.0 mmHg, Na+ 131 mEq/L, glucose 666 mg/dL; Cr 0.72 mg/dL, HbA1c 15.6%, urine ketone >7.8 mmol/L. Abdominal CT/US imaging found no infection/malignancy. She was diagnosed with acute kidney injury and severe DKA. She was started on saline infusion (4L for the first 24 h; NEJM2018;378:2275), continuous venous insulin infusion and 5% glucose solution for 12 hours. Repeat ABG showed pH 7.346, HCO3- 16.4, Na+ 137. As soon as she was initiated on insulin glargine ten units, she was transferred to a medical ward in Tokyo. Further examinations revealed FPG 241 mg/dL, FCPR 0.29 ng/mL, α-GAD 64 0U/mL. She was diagnosed with type 1 diabetes and was discharged with a basal-bolus regimen with a total daily dose of 23 units. No neurological impairment observed. AG normalization time was approximately eight hours in PICU setting and was <12 h, in this case, in medical ward.