A case report of dengue hemorrhagic fever complicated with diabetic ketoacidosis in a child: challenges in clinical mana
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(2020) 20:403
CASE REPORT
Open Access
A case report of dengue hemorrhagic fever complicated with diabetic ketoacidosis in a child: challenges in clinical management V. Thadchanamoorthy1 and Kavinda Dayasiri2*
Abstract Background: Diabetic ketoacidosis (DKA) is a common presentation of type 1 diabetes mellitus (T1DM) precipitated by various bacterial and viral infections. Dengue infection is no exception for this and can be a precipitating factor for DKA. The presentation of DKA with dengue haemorrhagic fever (DHF) has been reported in adults. However, it is very rarely observed in children. Case presentation: We present the case of a paediatric patient who was previously healthy and subsequently, developed polyuria (above 3 ml/kg/hour), irritability and high blood glucose (724 mg/dl) during the critical phase of DHF. DKA was diagnosed with DHF and managed successfully with insulin and intravenous fluids. He recovered without complications and discharged home with follow up being arranged at the endocrinology clinic. Conclusions: When both DHF and DKA present together in a patient, meticulous monitoring of glycaemic control as well as fluid management is required to reduce the potential risk for severe complications of both conditions. Since there are no similar paediatric case reported in the literature, this case report might inspire paediatricians to anticipate the possibility of DKA in children with DHF. Keywords: DKA, Fluid therapy, DHF
Background Dengue has a wide spectrum of clinical manifestations which may be mild to severe and can be severe enough to cause death due to dengue shock syndrome. Worldwide estimates suggest that annual incidence of dengue fever and DHF has been 100 million and 500,000 respectively. Ninety percent of DHF cases are children under 15 years old [1, 2]. Dengue fever similar to other viral infections is known to precipitate diabetic ketoacidosis in patients with diabetes. Both insulin dependent and independent diabetes can increase the release of pro-inflammatory cytokines and intensify the risk of plasma leakage in dengue fever. Acute pancreatitis is a * Correspondence: [email protected] 2 Base Hospital, Mahaoya, Sri Lanka Full list of author information is available at the end of the article
rare complication of severe dengue infection, which could be a contributory factor for diabetic ketoacidosis. The clear understanding of the comorbidity and mortality between the two diseases is vital in patient management during acute illness. There is only limited research evidence with regard to actual fluid requirement during critical phase of dengue haemorrhagic fever as plasma leakage is dynamic and can occur at different rates across the critical phase [3]. Therefore, current practice of fluid management in DHF depends, to a greater extent, on expertise of the managing clinicians and a number of assumptions regarding evolution of plasma leakage. Urine output is considered as a reliable indicator of haemodynamic stability in patients with DHF and maintaining urine output bet
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