Page 188 - Abstract Book KONIKA 18

Endocrinology

P-ENDO-023
A 7-year-old Child with Diabetic Ketoacidosis Discharged Directly from PICU
after 24 Hours of Hospitalization: A Case Report

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1
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1
Runi Arumndari , Muhammad Hadley Aulia , Asterisa Retno Putri ,Yohannes Ricky Permadi ,
Frida Soesanti 1,2
Brawijaya Women and Children Hospital and Pediatric Endocrinology Division, Department of Child Health, Faculty
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2
of Medicine Universitas Indonesia , Jakarta, Indonesia
Abstract
Background Diabetic ketoacidosis (DKA) is an acute and life-threatening complication in children with
type-1 diabetes mellitus (T1DM). DKA requires a closely-monitored treatment in the pediatric intensive
care unit (PICU). They usually transferred from PICU to the inpatient ward before being discharged, but
there were some detaining problems in the developing countries e.g. financial problem and room availability.
Objective To demonstrate the possibility of discharging a young child with DKA directly from PICU after
24 hours treatment. Case A 7-year-old boy with moderate DKA was referred to our hospital. He was fully
conscious, had initial blood glucose level at 721 mg/dL, and blood gas analysis showed pH 7.299 and HCO
3.8 mEq/L. He was transferred to PICU, given two-bag system and insulin drip that discontinued after 14
hours. Meanwhile, his parents said that they wanted to be discharged due to financial difficulty. Fortunately,
his DKA was resolved in less than 24 hours and could be discharged directly from PICU. Since the patient
admitted to PICU, his mother was given very intensive educations to prepare for ambulatory management
to ensure good glycaemic control and prevent any episodes of DKA. After his mother was confidence to
manage the T1DM at home, the patient was discharged. A week later during clinic’s follow up, he looked
healthier, had gain back some weight, and good blood monitoring. There was no episode of hypoglycaemia
at home. Conclusion With good and meticulous education, it was possible to discharged DKA patient
directly from PICU.
Keywords: moderate DKA; PICU; education

P-ENDO-024
Comprehensive Management of Young Children
with Severe Diabetic Ketoacidosis: A Case Series

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Asterisa Retno Putri , Muhammad Hadley Aulia , Fisaura Unsa , Destya Nora , Frida Soesanti 1,2
1
Brawijaya Women and Children Hospital and Pediatric Endocrinology Division, Department of Child Health,
Faculty of Medicine Universitas Indonesia , Jakarta, Indonesia
2
Abstract
Background As a life-threatening complication of type-1 diabetes mellitus (T1DM), DKA continues to have
high rates of morbidity and mortality. Not only do children with DKA need a closely-monitored treatment in
the pediatric intensive care unit (PICU), but also a comprehensive treatment. Objective To demonstrate that
the comprehensive treatment of DKA patients started from PICU since admission. Case A 7-year-old girl
and a 3-year-old boy were referred to our hospital, both came with letargic, kussmaul breathing, with initial
blood glucose 542 mg/dL, and blood gas analysis showed evidence of severe metabolic acidosis (pH <7.1
and/or HCO3 <5), both present the sign of dehydration. They had history of polydipsia, polyuria, and also
loss of weight but with normal/increase appetite. At the intensive care both were given two-bag system and
continuous intravenous insulin. After one day care at PICU, both were fully conscious, the intravenous fluids
discontinued, and transferred to hospital ward. Both patients still adjustment of the subcutaneous insulin.
During treatment their parents were given the comprehensive education since admission to PICU regarding
T1DM and its principal management, how to manage blood glucose level, adjust the subcutaneous insulin
at home, and how to do carbohydrate counting. The patient was discharged at fourth-day of hospitalization.
During 3 months follow-up in outpatient clinics, the blood glucose was well controlled with good level of
HbA1c. Conclusion Comprehensive management of DKA in T1DM including education to parents should
be started as early as patient’s admitted to PICU.
Keywords: DKA; severe DKA; education; comprehensive treatment

140 KONIKA XVIII Abstract Book