Late diagnosis of diabetic ketoacidosis and underlying disease influence response to treatment

Commentary

This patient with diabetic ketoacidosis has the chylomicronaemia syndrome with plasma triglyceride concentrations in excess of about 45 mmol/l as judged by the presence of lipaemia retinalis. In addition, cerebral oedema, lactic acidosis, pancreatitis, and sepsis may also be present.

A reduced level of consciousness in a child with diabetic ketoacidosis may indicate the presence of cerebral oedema. The potential consequences of cerebral oedema justify immediate administration of intravenous mannitol followed by computed tomography or magnetic imaging resonance scanning of the brain to confirm or refute this diagnosis. The diabetic ketoacidosis should be managed in the usual manner with particular attention paid to maintaining optimal fluid balance and glucose control. …