Page 184 - Abstract Book KONIKA 18

Endocrinology

P-ENDO-015
Moderate Diabetic Ketoacidosis Treated with Subcutaneous Rapid-Acting Insulin
Administration was Resolved Less than 12 Hours: A Case Report

1
1
1
Mulki Angela , Dian Wulandaru SP , Pebriansyah , Radhian Amandito , Aman B. Pulungan 2
1
1
Pediatric Resident and Department of Child Health , Faculty of Medicine, Universitas Indonesia/
2
Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Abstract
Background Diabetic ketoacidosis (DKA) is one of complications that will lead to mortality in patient with
type 1 diabetes (T1D). The ideal approach to treat DKA is using intravenous (IV) insulin administration with
hourly monitoring of blood glucose. In COVID-19 pandemic era, the alternative administration strategy to
reduce the contact exposure of healthcare workers with patients should be performed. Subcutaneous (SC)
rapid-acting insulin analog administration is a solution to this ongoing issue. Objective To perform SC rapid-
acting insulin administration to treat DKA. Case 11-year-old boy was admitted to emergency room (ER) with
a chief complaint of vomiting since 1 day prior to admission. There was no history of loss of consciousness,
seizure, fever, shortness of breath, or diarrhea. Since 1 day prior to admission, the administration of SC
rapid-acting insulin was omitted, due to shortage of medication at home. He was diagnosed with T1D since
he was 7 years old. He had history of DKA 5 times before. Due to COVID-19 pandemic, family moved
to the village and he did not do routine visit to the pediatrician. At ER his blood glucose was 370 mg/
dL, blood ketone was 5,6 mmol/L and blood gas analysis result was metabolic acidosis (pH 7.269; HCO
3
8.2 mEq/L). We did fluid resuscitation firstly. We started SC rapid-acting insulin administration from
0.3 units/kg, and subsequently tapered off. DKA was resolved less than 12 hours. Conclusion In mild to
moderate DKA, treatment with SC rapid-acting insulin could be effectively performed.
Keywords: diabetic ketoacidosis; subcutaneous insulin

P-ENDO-016
Bifid Scrotum, Scrotal hypospadias, and Severe Chordee in Newborn:
A case report

Callista Beatrice, I Wayan Bikin Suryawan
Department of Child Health, General Hospital of Wangaya, Denpasar, Bali, Indonesia

Abstract
Background Congenital abnormalities of the scrotum are rare and sometimes associated with other
genitourinary tract abnormalities. This report presented a newborn with multiple genitourinary anomalies,
including bifid scrotum, scrotal hypospadias, and severe chordee. Objective To identify multidisciplinary
approaches for diagnostic and management in such cases. Case Late preterm, appropriate for gestational
age baby was born at 35 weeks of gestation age by cesarean delivery, birth weight of 1850 grams, length of
44 cm, and APGAR score 8/9. Initial physical general examinations showed bifid scrotum, severe chordee,
and scrotal hypospadias. Bilateral testes were fully descended and palpable in both scrotum sac. The anus
was normal in position. Mother had preeclampsia but denied neither consumption of antihypertensive
drugs and alcohol nor teratogens exposure. No family history of hypospadias or other urogenital anomalies.
The baby was referred to the pediatric endocrinologist and urologist. Initial testosterone level was low at
63.17 ng/dL (five days yo). Low testosterone (hypogonadism) suggested the possibility of testosterone
biosynthetic defect, 5α-reductase deficiency, or androgen insensitivity syndrome. Karyotyping, HCG
stimulation test at six months old, and reconstructive surgery before twelve months old were planned for
further investigations and management. Conclusion Multidisciplinary teams and approaches are needed
in congenital anomalies of the scrotum and other genitourinary tract abnormalities, including hormone
evaluation, genetic karyotyping, and surgery.
Keywords: bifid scrotum; scrotal hypospadias; severe chordee

136 KONIKA XVIII Abstract Book