Paediatric Diabetic Ketoacidosis in Newly-Diagnosed Type1 Diabetes: Delayed Diagnosis and Unexpected Development of Systemic Hypertension During Therapy

Background: Delayed diagnosis of paediatric diabetic ketoacidosis (DKA) is known to be common but development of systemic hypertension during therapy is unexpected. The aim of the report is to increase awareness among physicians that systemic hypertension could develop during therapy even if the blood pressure was normal at presentation.

Case Presentation: A case of a 17-year-old girl who presented in our Children’s Emergency Department with in newly-diagnosed type 1 diabetes complicated by ketoacidosis. The patient was earlier seen in two different hospitals within 72 hours where diagnoses of malaria and sickle cell anaemia crisis were made, respectively. She had severe dehydration but no hypotension. Intravenous fluid was administered to her in a referral hospital for suspected sickle cell anaemia with vaso-occlusive crisis. Laboratory findings included hyperglycaemia (random blood glucose 20.8mmo/L; 347mg/dl), acidosis (serum bicarbonate 5mmol/L), ketonuria 2+; glycosuria 2+, and urine specific gravity of 1.015. At admission, the blood pressure was 100/60mmHg (< 50th percentile for both systolic and diastolic blood pressure) but progressively rose to 140-180/80-100mmHg (> 99th percentile) by the third day on admission.

Conclusion: In adolescents with DKA, a more frequent measurement of blood pressure is justified throughout the period of hospital admission, even when admission blood pressure is normal.

Keywords: Adolescence, delayed diagnosis, diabetic ketoacidosis, type 1 diabetes, hypertension.