Treatment of septic shock in two pediatric patients with severe diabetic ketoacidosis using invasive hemodynamic monitoring: a case report

被引:0
作者
Saeed, Amir [1 ]
Ziyaee, Fateme [2 ]
机构
[1] Shiraz Univ Med Sci, Dept Pediat, Div Intens Care Unit, Shiraz, Iran
[2] Shiraz Univ Med Sci, Dept Pediat, Zand Ave, Shiraz, Iran
关键词
Diabetic ketoacidosis; Invasive hemodynamic monitoring; Septic shock; Case report; MORTALITY; CHILDREN; DEHYDRATION; SEPSIS;
D O I
10.1186/s12902-023-01315-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BackgroundDiabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus. DKA associated with shock is a rare condition that occurs due to the fluid deficit or septic shock. It is not easy to differentiate these two conditions by clinical judgment and laboratory findings. Although the fluid therapy is the mainstay in DKA treatment, it looks like a double-edged sword-underhydration may result in organ failure whereas overhydration may lead to pulmonary and cerebral edema (CE).Case presentationHerein, we report on two pediatric patients presenting with DKA and septic shock. The first patient was an 8-year-old boy newly diagnosed with type 1 diabetes mellitus (T1DM) who presented with DKA and septic shock. We used a device for continuous hemodynamic monitoring (proAQT) to estimate his volume status. The patient was extubated 48 hours of hospitalization; the DKA was resolved after 52 hours of admission. He was discharged home in good condition on the 5th day. The second patient was a 13-year-old girl, a known case of T1DM, who presented with mixed DKA- hyperosmolar-hyperglycemic state (HHS) and septic shock. She was intubated and treated according to the data derived from pulse Contour Cardiac Output (PiCCO). After 3 days, she was extubated and transferred to the ward in good condition.ConclusionUsing invasive hemodynamic monitoring in critically ill children with severe DKA and hypotension might guide the physicians for hydration and selecting the most appropriate inotrope.
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