Extreme hyperosmolarity and severe ketoacidosis in a child with type 1 diabetes mellitus at onset safely treated with current guidelines

  • G. TontiEmail author
  • G. Maltoni
  • A. Cassio
  • S. Zucchini
Case Report


Type 1 diabetes mellitus (T1DM) is an autoimmune disorder characterized by the destruction of pancreatic beta cells by autoantibodies resulting in low or no production of endogenous insulin. The incidence of T1DM is extremely variable depending on the countries, and it is progressively growing [1]. Ketoacidosis (DKA) is present at diagnosis in 15–70% of patients affected by T1DM and is more frequent in children younger than 2 years of age, in case of delayed diagnosis, in some ethnic minorities and in children with poor access to medical care for socio-economic reasons [1]. DKA is defined by the presence of hyperglycaemia (blood glucose > 200 mg/dL), venous pH < 7.3 or serum bicarbonate < 15 mmol/L, ketonemia (blood β-hydroxybutyrate ≥ 3 mmol/L) or moderate or large ketonuria. Clinically, it shows through dehydration, tachycardia, tachypnea, sighing (Kussmaul) respiration, nausea, vomiting, abdominal pain and confusion state up to coma [1]. The hyperglycaemic hyperosmolar...


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

Informed consent was obtained from the patient for being included in the study.


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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2019

Authors and Affiliations

  1. 1.Azienda Ospedaliero-Universitaria of Bologna, Sant’Orsola-Malpighi HospitalBolognaItaly

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