DS Park, YS Lee, EY Joo, JE Lee

Abstract

Background: The fear of coronavirus disease-2019 (COVID-19) and long-term social isolation measures has led to unintended consequences, including delayed diagnosis and treatment of diabetes mellitus (DM), and increasing incidence of diabetic ketoacidosis (DKA). Acute mesenteric ischaemia (AMI) is a rare, but rapidly serious abdominal process associated with DKA. We report a fatal paediatric case who presented with DKA associated with rapidly deteriorating AMI during the pandemic period. The patient delayed medical care during the pandemic due to concerns about COVID-19. Case Presentation: A previously healthy 13-year-old girl presented to the emergency department with vomiting, lethargy, polyuria, polydipsia, and weight loss. She was newly diagnosed with DM complicated with severe DKA. Despite intensive fluid and insulin therapy, her condition deteriorated rapidly, and she was identified as having extensive pneumatosis intestinalis suggestive of gangrenous bowel perforation caused by acute mesenteric ischaemia. The patient subsequently could not be resuscitated. Conclusion: AMI should be initially suspected in patients with severe DKA, even having a soft abdomen in childhood DKA. Increased awareness of pediatric DKA can prevent delays in medical care for early diagnosis of AMI.