Introduction: Euglycemic Diabetic Ketoacidosis (eDKA) is characterized by ketonemia, metabolic acidosis (pH <7.3 and serum bicarbonates <18 mEq/L), and euglycemia (blood glucose <250 mg/dL). The mechanism of eDKA on insulin pump therapy involves a state of starvation, leading to ketosis while normoglycemia is maintained. The diagnosis of eDKA is often overlooked because euglycemia masks the underlying diabetic ketoacidosis. To the best of our knowledge, only three cases of adolescents with T1D on insulin pump therapy have been reported so far, establishing the rarity of eDKA in pediatrics. Objectives: To assess the occurrence of eDKA in 67 children and adolescents with T1DM using advanced hybrid closed-loop systems (aHCL). Methods: Retrospective analysis of admissions to the Emergency Department from September 2021 to October 2023. Results: We recorded two admissions with eDKA, both in preschool girls (aged 3 and 6 years) during gastroenteritis. The 3-year old girl is affected by Down syndrome and presented symptoms from two days; at admission, her pH was 7.29, bicarbonates 15.3 mEq/L, ketonemia 7.3 mmol/L, and glycemia 130 mg/dL. The 6-year-old girl developed several gastroenteritis episodes in the previous five days and presented with pH 7.29, bicarbonates 16.8 mEq/L, ketonemia 5.6 mmol/L, and glycemia 132 mg/dL. Both were in auto mode at the time of admission and were treated with discontinuation of the insulin pump, fluid resuscitation, and continuous insulin infusion associated with glucose saline until resolution of ketoacidosis. The discontinuation of the insulin pump continued for four hours and twelve hours, respectively. Conclusions: To the best of our knowledge, this is the first report of eDKA in preschool children with T1DM using aHCL. The two patients presented were preschool-aged, reflecting that the vicious cycle between underfeeding and ketosis occurs more frequently in younger children.
Euglycemic diabetic ketoacidosis in preschool children with type 1 diabetes mellitus using advanced hybrid closed loop system
G. Tamaro
;S. Solidoro;G. Tornese
2024-01-01
Abstract
Introduction: Euglycemic Diabetic Ketoacidosis (eDKA) is characterized by ketonemia, metabolic acidosis (pH <7.3 and serum bicarbonates <18 mEq/L), and euglycemia (blood glucose <250 mg/dL). The mechanism of eDKA on insulin pump therapy involves a state of starvation, leading to ketosis while normoglycemia is maintained. The diagnosis of eDKA is often overlooked because euglycemia masks the underlying diabetic ketoacidosis. To the best of our knowledge, only three cases of adolescents with T1D on insulin pump therapy have been reported so far, establishing the rarity of eDKA in pediatrics. Objectives: To assess the occurrence of eDKA in 67 children and adolescents with T1DM using advanced hybrid closed-loop systems (aHCL). Methods: Retrospective analysis of admissions to the Emergency Department from September 2021 to October 2023. Results: We recorded two admissions with eDKA, both in preschool girls (aged 3 and 6 years) during gastroenteritis. The 3-year old girl is affected by Down syndrome and presented symptoms from two days; at admission, her pH was 7.29, bicarbonates 15.3 mEq/L, ketonemia 7.3 mmol/L, and glycemia 130 mg/dL. The 6-year-old girl developed several gastroenteritis episodes in the previous five days and presented with pH 7.29, bicarbonates 16.8 mEq/L, ketonemia 5.6 mmol/L, and glycemia 132 mg/dL. Both were in auto mode at the time of admission and were treated with discontinuation of the insulin pump, fluid resuscitation, and continuous insulin infusion associated with glucose saline until resolution of ketoacidosis. The discontinuation of the insulin pump continued for four hours and twelve hours, respectively. Conclusions: To the best of our knowledge, this is the first report of eDKA in preschool children with T1DM using aHCL. The two patients presented were preschool-aged, reflecting that the vicious cycle between underfeeding and ketosis occurs more frequently in younger children.Pubblicazioni consigliate
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