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      A rare diabetes ketoacidosis in combined severe hypernatremic hyperosmolarity in a new-onset Asian adolescent with type I diabetes

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      BMJ Case Reports
      BMJ Publishing Group

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          Abstract

          A 13-year-old Asian boy presented with an 8 h history of lethargy and vomiting. He had a 3-week history of polyuria, polydipsia and a 6 kg weight loss over a period of 1 month. Fluid intake prior to admission was over 6 L of sports drinks and cola per day. Initial biochemical findings were as follows: plasma glucose 1351 mg/dL, serum sodium 154 mEq/L, serum osmolarity 425 mOsm/L, arterial blood pH 6.96 and urine ketone of 3+. He was treated with intensive fluid resuscitation and an insulin infusion. He completely recovered without any neurological deficits. Severe hypernatremia is rare in diabetic ketoacidosis (DKA) but was exhibited in this case. Excess intake of carbonated carbohydrate-rich beverages may exacerbate the initial severe presentation of type I diabetes mellitus (T1DM). To the best of our knowledge, this is the first case of an Asian child with DKA combined with severe hypernatremic hyperosmolarity at onset of T1DM.

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          Author and article information

          Journal
          BMJ Case Rep
          BMJ Case Rep
          casereports
          bmjcasereports
          BMJ Case Reports
          BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
          1757-790X
          2014
          17 December 2014
          : 2014
          : bcr2014208016
          Affiliations
          Department of Pediatrics, Inha University School of Medicine, Inha University Hospital , Incheon, Republic of Korea
          Author notes
          [Correspondence to ] Associate Professor Ji Eun Lee, anicca@ 123456inha.ac.kr
          Author information
          http://orcid.org/0000-0002-7386-0015
          Article
          PMC4275750 PMC4275750 4275750 bcr-2014-208016
          10.1136/bcr-2014-208016
          4275750
          25519868
          3b15730e-8745-47fd-b3d6-e022ed2f0ccb
          2014 BMJ Publishing Group Ltd
          History
          : 28 November 2014
          Categories
          Article
          1523
          Rare Disease
          Male
          13-18 years
          Other Asian
          Asia
          Case Report

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