Komang Triyunita Santyadewi, Gede Angga Dharmadiputra, I Putu Bagus Darma Putra, I Wayan Bikin Suryawan

Multisystem complications in pediatric diabetic ketoacidosis with cerebral oedema, renal dysfunction, and delayed menarche: a case report

Introduction

Multisystem complications in pediatric diabetic ketoacidosis with cerebral oedema, renal dysfunction, and delayed menarche: a case report. Severe pediatric DKA case: cerebral oedema, renal dysfunction, delayed menarche in adolescent. Multisystem complications of type 1 diabetes discussed.

Abstract

Introduction: Diabetic ketoacidosis is a serious acute complication of type 1 diabetes mellitus in children and may become life-threatening when complicated by cerebral oedema. In Indonesia, the increasing incidence of type 1 diabetes and the high frequency of diabetic ketoacidosis related to poor treatment adherence highlight the importance of early recognition and management. This report aims to describe severe diabetic ketoacidosis complicated by suspected cerebral oedema, renal dysfunction, and delayed pubertal development manifested as delayed menarche in an adolescent patient. Case Description: A 15-year-old female with type 1 diabetes mellitus presented with decreased consciousness, vomiting, dyspnea, and generalised weakness after poor adherence to insulin therapy for two weeks. The patient’s mother reported that the patient had not experienced menarche. Physical examination showed impaired consciousness with a Glasgow Coma Scale score of E3V3M5 and delayed pubertal development. Laboratory evaluation revealed severe hyperglycemia, metabolic acidosis, electrolyte imbalance, leukocytosis, elevated blood urea and creatinine levels indicating renal dysfunction, and cerebral oedema. The patient was diagnosed with severe diabetic ketoacidosis complicated by cerebral oedema, renal dysfunction, and delayed menarche. Management included intravenous fluids, continuous insulin infusion, mannitol administration, close neurological monitoring, correction of metabolic abnormalities, and family education. Following appropriate therapy and intensive monitoring, the patient showed gradual clinical improvement and was discharged in stable condition. Conclusion: Severe diabetic ketoacidosis in adolescents may present with both acute life-threatening complications and chronic consequences of poor glycemic control, including cerebral oedema, renal dysfunction, and delayed pubertal development.

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