title: A rare diabetes ketoacidosis in combined severe hypernatremic hyperosmolarity in a new-onset Asian adolescent with type I diabetes.
abstract: A 13-year-old Asian boy presented with an 8 h history of lethargy and vomiting. He had a 3-week history of polyuria, polydipsia and a 6 kg weight loss over a period of 1 month. Fluid intake prior to admission was over 6 L of sports drinks and cola per day. Initial biochemical findings were as follows: plasma glucose 1351 mg/dL, serum sodium 154 mEq/L, serum osmolarity 425 mOsm/L, arterial blood pH 6.96 and urine ketone of 3+. He was treated with intensive fluid resuscitation and an insulin infusion. He completely recovered without any neurological deficits. Severe hypernatremia is rare in diabetic ketoacidosis (DKA) but was exhibited in this case. Excess intake of carbonated carbohydrate-rich beverages may exacerbate the initial severe presentation of type I diabetes mellitus (T1DM). To the best of our knowledge, this is the first case of an Asian child with DKA combined with severe hypernatremic hyperosmolarity at onset of T1DM.
authors.affiliation: Department of Pediatrics, Inha University School of Medicine, Inha University Hospital, Incheon, Republic of Korea.
authors.forename: Hyung Jin
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Inha University School of Medicine, Inha University Hospital, Incheon, Republic of Korea.
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Inha University School of Medicine, Inha University Hospital, Incheon, Republic of Korea.
authors.forename: Yong Hoon
authors.initials: YH
authors.lastname: Jun
authors.affiliation: Department of Pediatrics, Inha University School of Medicine, Inha University Hospital, Incheon, Republic of Korea.
authors.forename: Ji Eun
authors.identifier: http://orcid.org/0000-0002-7386-0015
authors.initials: JE
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D044466:Asian People; D001628:Beverages; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D016883:Diabetic Ketoacidosis / Q000209:etiology* / Q000628:therapy; D004040:Dietary Carbohydrates / Q000009:adverse effects*; D005440:Fluid Therapy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006955:Hypernatremia / Q000209:etiology* / Q000628:therapy; D007328:Insulin / Q000627:therapeutic use; D007662:Ketosis / Q000209:etiology; D008297:Male; D009994:Osmolar Concentration; D012964:Sodium / Q000097:blood
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D007328:Insulin; D012964:Sodium