Clinical Case of Late Diagnosed Diabetes in Ketoacidotic Coma III in Teenager: Lessons to be Learned

The general condition at admission is extremely severe. Consciousness at the level of coma II. Skin was dry, pale in color. Body temperature with elevations up to 38.6C. The tongue was dry, densely coated with white coating. Cussmaul's breath, BR 36 per minute, the smell of ketones in the exhaled air. Pulse 128 per min. BP 100/60 mm Hg. Diuresis: polyuria. Glycemia at admission was 30.4mmol/L, ketones in urine: ++++. CBC, urine, biochemical analysis of blood had not any special features. The central vein was catheterized. Nasogastric tube and Foley's bladder catheter were placed. Intensive therapy was initiated immediately: infusion therapy started with saline, small doses of regular insulin intravenously, correction of electrolyte abnormalities: potassium within infusion solutions, heparin therapy, anti bacterial therapy using wide spectrum antibiotics. In the dynamics of the phenomenon of increasing respiratory failure and falling hemodynamics, the patient was intubated, pulmonary ventilation was started in the SIMV mode, inotropic support with dopamine, norepinephrine, and dobutamine started. On this background on the 3 rd day the patient had cardiac arrest, after resuscitation heart activity was restored in 10 minutes. Consciousness at the level of coma III with periods of psychomotor agitation and tonic-and-clonic convulsions. In the lungs: left-sided upper-lobe large-focal pneumonia, Pseudomonas Aeruginosae was found in the sputum. Intensive therapy: infusion therapy (saline, glucose 5% and 10% solution), insulin therapy, potassium solutions, heparin, antibacterial therapy according to sensitivity.

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