The acute complications of diabetes mellitus include diabetic ketoacidosis and hyperglycemic
hyperosmolar syndrome. Acute complications of uncontrolled hyperglycemia with life-threatening
consequences can occur if not recognized and treated early. Let's go to this case. A 10-year-old boy
is brought to the emergency department by his mother due to frequent vomiting, abdominal pain, and
weakness. Over the last 5 days, he felt excessively thirsty and has been urinating frequently.
Family history is non-contributory. His temperature is 37.1°C, his blood pressure is 100/70, and
his pulse rate 110 beats/minute. On physical exam, he is non-responsive to verbal commands.
He has sunken eyes, poor skin turgor, and rapid deep respirations. His lab findings reveal a random
plasma glucose of 460 mg/dL. He has an undetectable fasting C-peptide, his serum beta-hydroxybutyrate
is elevated, and his GAD antibodies are positive. What is the most likely diagnosis? This is a
young boy with vomiting, abdominal pain, and weakness that is progressive. He also manifested
with polydipsia and polyuria. Signs of dehydration and tachypnea, that is shallow and rapid
respiration, are also present which makes us suspect a respiratory alkalosis. He also has profound
hypoglycemia. The presence of undetectable fasting C-peptide is an indication that he has no
endogenous insulin production. Also, the fact that his serum ketones are elevated confirms the
presence of diabetic ketoacidosis. And finally, the positive GAD antibodies imply that the etiology
of his type 1 diabetes is an immune-mediated process. And confirming the diagnosis, this young
boy has presented in acute diabetic ketoacidosis. DKA typically occurs in the setting of hypoglycemia
with relative or absolute insulin deficiency and an increase in counter-regulatory hormones.
Sufficient amount of insulin are not present to suppress lipolysis and oxidation of free fatty
acids. This in turn leads to ketone body production by the body and a subsequent metabolic acidosis.
DKA occurs more frequently with type 1 diabetes, although 10-30% of it can occur in patients
with type 2 diabetes. It may be the initial clinical presentation in some patients with previously
undiagnosed type 1 or type 2 diabetes.