Diabetic ketoacidosis due to neonatal diabetes mellitus in 2 months old infant

Sitoresmi Prabaningrum, Novina, Faisal, R.M Ryadi Fadil

Departement of Child Health,Faculty of Medicine Universitas of Padjajaran
Hasan Sadikin General Hospital, Bandung, Indonesia
Background
Neonatal diabetes mellitus is a rare metabolic disorder, affecting approximately 1 in 500,000
live births and may be either transient or permanent. Affected neonates frequently present
with hyperglycemia, intrauterine growth retardation, and variable degrees of dehydration.
Genotyping identifies the exact unique molecular aetiology of very early onset insulin
requiring diabetes and has the potential to dramatically alter the management of the patient,
who would otherwise be insulin dependent for life.
Objective
To diagnose and management of diabetic ketoacidosis in a patient with neonatal diabetes
mellitus.
Case illustration
An infant 2 months old with diabetic ketoacidosis. The patient presented with chief complain
of dyspnea. Physical examination revealed sign of dehydration, tachycardia and fever. From
history taking the patient had polyuria, polydipsi and intrauterine growth retardation. The
laboratory analysis showed hyperglycemia, metabolic acidosis, ketonuria, low level of Cpeptide and negative antibody for islet cell. There were fluctuation in blood glucose level
during monitoring, the range of glucose level was 20 mg/dl to 1057 mg/dl. Genetic molecular
analysis was in progress until this case report released. The patient was treated with regular
insulin infusion in acute period and was converted to oral sulphonylureas after the condition
was stable.
Conclusion
Correct identification and appropriate management of diabetic ketoacidosis will gives optimal
blood glucose control in patient with neonatal diabetes mellitus.
Keywords: diabetic ketoacidosis, neonatal diabetes, sulphonylurea