Recurrent Diabetic Ketoacidosis in Adolescents with Type 1 Diabetes Mellitus

Introduction: Diabetic ketoacidosis (DKA) is one of the serious complications that is often found in pediatric cases of type 1 diabetes mellitus (DM). Diabetic ketoacidosis mostly occurs in patients with low glycemic control. Currently, many studies are assessing risk factors for recurrent ketoacidosis, including young age, male gender, patients with comorbidities (psychiatric diseases, alcohol or substance abuse, other chronic diseases), and patients with socioeconomic factors. The incidence of recurrent diabetic ketoacidosis in children and adolescents is becoming more frequent. Risk factors that often trigger the incidence of diabetic ketoacidosis are important to understand to reduce the incidence of recurrent DKA. Case Presentation: This study reported a 17-year-old adolescent patient with a history of type 1 diabetes mellitus who had recurrent diabetic ketoacidosis. Patients come with complaints of nausea and vomiting, accompanied by a feeling of weakness. The results of the blood glucose test were 565 mg/dL. In urinalysis, a reduction of glucose was obtained (+3), and ketonuria with urinary ketones was obtained with a result of +3. A blood gas analysis showed a blood pH of 7,367 mmHg with HCO3 of 16.6 mmol/L and PCO2 of 28.6 mmHg. The initial management of the patient was given a loading of 0.9% NaCl fluid as much as 500 cc/hour for 2 hours, then 0.9% NaCl fluid as much as 500 cc mixed with KCL 10 meq at a rate of 75 ml/hour. The patient was also given an insulin drip to correct blood glucose levels in the form of 5 IU of insulin diluted with 0.9% NaCl, as much as 50 cc. During treatment, the patient's condition tends to stabilize, and the patient is discharged from the hospital by continuing with routine treatment with subcutaneous insulin. Conclusion: Diabetic ketoacidosis is one of the complications with high morbidity and mortality, especially in patients with type 1 diabetes mellitus. There are several risk factors associated with recurrent DKA in patients. Known risk factors for DKA allow health workers to prevent the occurrence of a recurrence of DKA.