DOI 10.1515/jpem-2013-0216 J Pediatr Endocr Met 2015; 28(1-2): 73–74
Images in pediatric endocrinology Nesibe Akyürek*, Mehmet Emre Atabek and Beray Selver Eklioglu
Intestinal invagination in diabetic ketoacidosis: case report Keywords: child; intestinal invagination; type 1 diabetes mellitus. *Corresponding author: Nesibe Akyürek, Department of Pediatric Endocrinology and Diabetes, School of Medicine, Necmettin Erbakan University, 42080 Konya, Turkey, Phone: +90-332-223-63-50, Fax: +90-332-223-6181, E-mail: [email protected] Mehmet Emre Atabek and Beray Selver Eklioglu: Department of Pediatric Endocrinology and Diabetes, School of Medicine, Necmettin Erbakan University, Konya, Turkey
An 11-year-old girl was admitted to the hospital (School of Medicine, Necmettin Erbakan University, Konya, Turkey) with complaints of polyuria, polydipsia, decreased appetite, and weight loss of 8 kg for a few weeks. She was born at term by normal vaginal delivery (birth weight 3400 g) from a healthy mother as the first child of the family. There was no consanguinity between the parents. No family history of diabetes was reported. Physical examination at the time of admission revealed a temperature of 36.2°C, a pulse of 99 bpm, a respiratory rate of 28 per min, and a blood pressure of 70/50 mm Hg. The patient’s height was 113.1 cm [(0.32 standard deviation score (SDS)] and her weight was 21.5 kg (0.74 SDS). Calculated body mass index was 16.8 kg/m2 (0.98 SDS). On admission, blood glucose was 500 mg/dL, blood gas analysis showed a pH of 6.7 and HCO3 of 2.8 mmol/L. The diagnosis of diabetic ketoacidosis (DKA) was made, oral intake was stopped and appropriate fluid and insulin therapy was started. On physical examination, she looked dehydrated and there was abdominal pain with diffuse tenderness in all quadrants. Afterwards bilious vomiting developed. An X-ray of the abdomen was performed that showed a huge air fluid level on the left side with paucity of distal gas shadows (Figure 1). Abdominal computed tomography showed huge air fluid level and invagination (Figures 2 and 3). The nasogastric tube was passed and the distension was decompressed. Baseline investigations were completed and the blood picture revealed hypopotasemia and
hyponatremia (sodium: 130 mEq/L, potassium: 2.8, respectively). Glycosylated hemoglobin A1c was 16.8. C-peptide level was
Images in pediatric endocrinology Nesibe Akyürek*, Mehmet Emre Atabek and Beray Selver Eklioglu
Intestinal invagination in diabetic ketoacidosis: case report Keywords: child; intestinal invagination; type 1 diabetes mellitus. *Corresponding author: Nesibe Akyürek, Department of Pediatric Endocrinology and Diabetes, School of Medicine, Necmettin Erbakan University, 42080 Konya, Turkey, Phone: +90-332-223-63-50, Fax: +90-332-223-6181, E-mail: [email protected] Mehmet Emre Atabek and Beray Selver Eklioglu: Department of Pediatric Endocrinology and Diabetes, School of Medicine, Necmettin Erbakan University, Konya, Turkey
An 11-year-old girl was admitted to the hospital (School of Medicine, Necmettin Erbakan University, Konya, Turkey) with complaints of polyuria, polydipsia, decreased appetite, and weight loss of 8 kg for a few weeks. She was born at term by normal vaginal delivery (birth weight 3400 g) from a healthy mother as the first child of the family. There was no consanguinity between the parents. No family history of diabetes was reported. Physical examination at the time of admission revealed a temperature of 36.2°C, a pulse of 99 bpm, a respiratory rate of 28 per min, and a blood pressure of 70/50 mm Hg. The patient’s height was 113.1 cm [(0.32 standard deviation score (SDS)] and her weight was 21.5 kg (0.74 SDS). Calculated body mass index was 16.8 kg/m2 (0.98 SDS). On admission, blood glucose was 500 mg/dL, blood gas analysis showed a pH of 6.7 and HCO3 of 2.8 mmol/L. The diagnosis of diabetic ketoacidosis (DKA) was made, oral intake was stopped and appropriate fluid and insulin therapy was started. On physical examination, she looked dehydrated and there was abdominal pain with diffuse tenderness in all quadrants. Afterwards bilious vomiting developed. An X-ray of the abdomen was performed that showed a huge air fluid level on the left side with paucity of distal gas shadows (Figure 1). Abdominal computed tomography showed huge air fluid level and invagination (Figures 2 and 3). The nasogastric tube was passed and the distension was decompressed. Baseline investigations were completed and the blood picture revealed hypopotasemia and
hyponatremia (sodium: 130 mEq/L, potassium: 2.8, respectively). Glycosylated hemoglobin A1c was 16.8. C-peptide level was
