Педиатрия и терапия
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Steroid Induced Diabetic Ketoacidosis (DKA) in a 13 year Old Female with Renal Disorder

Jaja T*,Anochie IC,Eke FU

Background: Diabetic ketoacidosis (DKA) is a common complication of poorly controlled diabetes mellitus in children and a rare complication of steroid therapy. Patients on steroid therapy may develop hyperglycemia as a complication, but presentation with DKA is rather unusual.
Aim: To highlight a rare clinical entity of DKA induced by prednisolone in a 13 year old female on treatment for nephrotic syndrome.
Case report: NC was a 13 year old female who presented with first episode of generalized body swelling, oliguria, massive proteinuria and hypercholesterolenaemia with normal renal function. She was not a known diabetic and had no family history of diabetes mellitus. She was started on prednisolone at 20 mg three times daily for nephrotic syndrome. Two weeks after commencement of prednisolone, she developed DKA with blood glucose of 31.1 mmol/l, glycosuria and ketonuria. She received intravenous insulin, fluids and was discharged on mixtard insulin with withdrawal of prednisolone. Her fasting blood sugar gradually normalized to between 3.1-4.5 mmo/L and insulin stopped after 4 months of treatment. She has remained normoglycaemic on follow up.
Conclusion: The possibility of hyperglycaemia and DKA should be anticipated on every adolescent on steroid therapy for nephrotic syndrome. We therefore recommend routine blood glucose monitoring for early identification of DM in order to avoid DKA in such patients.