Severe Ketoacidosis at Onset of Type 1 Diabetes in Children Due to Late Diagnosis

A case is reported of a young patient who presented to University Department of Pediatrics in Prishtina with a newly diagnosed diabetes in December 2006. On admission, the patient showed severe ketoacidosis due to the late diagnosis, in spite of two prior visits to a general practitioner. Biochemistry results on admission included serum glucose 35 mmol/L, venous pH 6.9, bicarbonates 4.8 mmol/L, Na 138 mmol/L, K 3.5 mmol/L, L 12,000, urea 6.5 mmol/L, creatinine 50 μmol/L and ketonuria +++. Treatment consisted of fluid replacement over 48 hours and careful monitoring of electrolytes and glycemia, based on the protocol issued by ESPE and American Diabetes Association. Children aged less than five years are more likely to present with diabetic ketoacidosis, partly as the result of their clinical presentation not having been recognized by health professionals as being compatible with diabetes, leading to a delay in the diagnosis and referral to hospital. We highlight the need for increased vigilance among general practitioners and pediatricians for the early presenting symptoms of diabetes in this vulnerable age group (0-4 years) in order to prevent diabetic ketoacidosis in new-onset diabetes and reduce its fatal complications, which could theoretically be achieved through a physician awareness campaign.