Page 190 - Abstract Book KONIKA 18

Endocrinology

P-ENDO-027
Diabetic Ketoacidosis Triggered by Retroauricular Abscess
in a Type 1 Diabetic Child

Rasio Putra Hutama, Muhammad Faizi, Nur Rochmah
Department of Child Health, Faculty of Medicine Universitas Airlangga/Dr.Soetomo General Academic Hospital,
Surabaya, East Java, Indonesia

Abstract
Background Diabetes ketoacidosis (DKA) is the most serious complication of diabetes. Retroauricular
abscess usually easy to control but in diabetes it may turn be severe and can triggers DKA. The formation
of abscesses in this region can cause severe lethal intracranial complications. In eleven years only 1 ear
infection can trigger diabetic ketoacidosis. We describe clinical features, laboratory, radiologic findings, and
management in this patient. The management of diabetic ketoacidosis together with source infection control
highlighted in this report. Objective To provide an overview of diagnostic and management of diabetic
ketoacidosis triggered by retroauricular abscess Case A 10-years-old girl came to Dr.Soetomo Hospital’s
emergency room, Surabaya, With shortness of breath, fever, vomiting, frequent micturition, otalgia, otorrhea,
asymmetrical face, and high blood glucose. She was diagnosed with type 1 diabetes mellitus at 4 years old.
Physical examination shows retroauricular undulation with peripheral 7 nervus paresis as a complication
th
of this abscess. The laboratory show hyperglycaemia, severe metabolic acidosis, ketonemia, leucocytosis,
thrombocytosis, high procalcitonin, glycosuria, and ketonuria but the chest x-ray, Schuller view was normal.
Pus culture from abscess is klebsiella pneumoniae that same as the pus culture from external acoustic meatus.
The management of this patient was rehydration, electrolyte correction, intravenous insulin pump, antibiotic,
and evacuation of the abscess. After 7 days of hospitalization, patient was discharged with controlled blood
sugar and well healing wound. Conclusion It is important to adequate multidisciplinary management of
DKA and consider an ear infection as a triggered DKA
Keywords: diabetic ketoacidosis; retroauriculer abscess; ear infection

P-ENDO-028
Hypoglycemia Treated with Subcutaneous Octreotide
in Children with Beckwith-Wiedemann Syndrome
Dian W. S. Pertiwi , Mulki Angela , Radhian Amandito , Pebriansyah , Ghaisani Fadiana , Frida Soesanti 2
1
1
1
2
1
1
Department of Child Health and Endocrinology Division , Department of Child Health, Faculty of Medicine,
2
Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Abstract
Background Beckwith-Wiedemann syndrome (BWS) is a pediatric overgrowth disorder presenting with
abdominal wall defects, macroglossia, and neonatal hypoglycemia. The estimated prevalence of BWS
is 1 in 10,340 live births. Early mortality may occur from complications of prematurity, hypoglycemia,
cardiomyopathy, or tumours. Objective To report a case of subcutaneous (SC) octreotide use in treating
hypoglycemia in patients with BWS. Case A 2-month-old boy presented with macroglossia, umbilical
hernia, feeding difficulties, and lethargic appearance since birth. The patient also had elevated blood insulin
level (5.2 mmol/L). Subsequent abdominal MRI with contrast showed finding of head of pancreas’ solid
tumour. On the initial admission, the random blood glucose level was 23 mg/dL, in which the patient
was treated with subcutaneous octreotide at a dose of 8.3 mcg/kg/day and intravenous glucose infusion
of 10 mg/kg/minute which was titrated daily. The blood glucose level was controlled within 2 weeks.
Nasogastric tube was inserted to ensure adequate nutritional intake and levothyroxine was also given for
treating the hypothyroidism. Genetic analysis confirmed paternal uniparental disomy (UPD) of 11p15.5.
Conclusion Hypoglycemia due to hyperinsulinemia can be effectively treated with SC octreotide in children
with Beckwith-Wiedemann syndrome.
Keywords: Beckwith-Wiedemann syndrome; hypoglycemia; hyperinsulinemia; octreotide

142 KONIKA XVIII Abstract Book