Page 196 - Abstract Book KONIKA 18

Endocrinology

P-ENDO-039
Subcutaneous Insulin Injection as an Alternative to Continuous Intravenous
Insulin in Mild to Moderate Diabetic Ketoacidosis: A Case Report

Fisaura Unsa , Runi Arumndari, Destya Nora , Yohannes Ricky Permadi , Frida Soesanti 1,2
1
1
1
1
1
Brawijaya Women and Children Hospital and Pediatric Endocrinology Division, Department of Child Health, Faculty
of Medicine Universitas Indonesia , Jakarta, Indonesia
2
Abstract
Background The standard protocol for insulin treatment in DKA is continuous IV insulin closely monitored
in PICU. In this COVID-19 pandemic era, intensive care unit become rarely available thus sometimes DKA
patient should be treated in non-ICU ward. For this circumstances, subcutaneous (SC) insulin injection
could be an alternative management for DKA. Objective To demonstrate the effectivity of subcutaneous
insulin injection in mild to moderate DKA. Case A 13-year-old girl was referred with severe DKA. She had
decreased level of consciousness, GCS of 14, blood glucose (BG) of 450 mg/dL, pH 7.08, serum bicarbonate
2.8, blood ketone 3.1. At previous hospital, she was treated with insulin IV for one hour and then changed to
SC rapid insulin every 2 hours, her initial insulin dose was 0.2 IU/kg. She was treated in previous hospital
for 12 hours before transferred to our hospital. At arrival, she was conscious, GCS 15, a slight Kusmaull
breathing, with BG of 97 mg/dL, pH 7.3, HCO 17 and ketone of 1.9. We continued the treatment with SC
3
rapid insulin of 0.1 IU/kg, every 2 hours combined with two-bags system IV fluid. DKA resolve after 20
hours of the onset and BG maintained at the normal range (97-161 mg/dL). She was discharged at fourth-
day of hospitalization. Conclusion Subcutaneous rapid insulin injection every 2 hours is effective in mild
to moderate DKA and can be an alternative treatment when intensive care is unavailable, especially during
COVID-19 pandemic era.
Keywords: subcutaneous insulin injection; diabetic ketoacidosis; pediatric

P-ENDO-040
Acquired Hypothyroidism in 14-year and 5-month-old Girl: A Case Report

1
Rasmi Diana , Ratna Dewi Artati 2
1
2
Department of Pediatric and Endocrinology Division , Department of Pediatric, Faculty of Medicine, Universitas
Hasanuddin/Dr. Wahidin Sudirohusodo General Hospital, Makassar, South Sulawesi, Indonesia
Abstract
Background Thyroid hormones play a major role in metabolism, growth and puberty. Hypothyroidism
is the most common thyroid dysfunction in children. The prevalence of congenital hypothyroidism
is 1 in 2,500-3,000 live births. The prevalence of acquired hypothyroidism is 1 in 1,250 live births.
Objective To report a case of Acquired Hypothyroidism in a child aged 14-year and 5-month-old. Case A
child aged 14-years and 5-months old came to the pediatric outpatient clinic. The child looked shorter than
other children at the same age. There was history of constipation and the patient was inactive. The academic
score was good. The child received levothyroxine since six years old but discontinued after one year. Physical
examination showed good nutritional status, severely stunted, there was no umbilical hernia nor non-pitting
edema in both extremities. Thyroid function tests showed low FT4 and high TSHs levels. Radiological
examination showed bone age of 8-years and 10-months (delayed bone age). Thyroid ultrasound showed
bilateral thyroid hypoplasia. IQ test was within normal limit. The child continued receiving levothyroxine,
and after ten months there was significant height gain and thyroid hormone levels became normal.
Summary A case of acquired hypothyroidism had been reported in a girl aged 14-year and 5-month-old.
Diagnosis was based on history taking, physical and laboratory examination, bone age and thyroid ultrasound.
The patient received oral levothyroxine and the prognosis was dubia ad bonam.
Keywords; Acquired Hypothyroidism, severely stunted, Levothyroxine.

148 KONIKA XVIII Abstract Book