Rare Neurologic Complications of Diabetic Ketoacidosis in a Child with Type ۱ Diabetes in Iran: A Case Report

Introduction: Peripheral neuropathy following ketoacidosis in children is very rare. In the present study, we report an ۸-year-old child with peripheral neuropathy followingdiabetic ketoacidosis in Iran. Methods: The present study is a case report Result: An ۸-year-old boy came to our emergency room following nausea, vomiting, abdominal pain, polydipsia and polyphagia. The patient's symptoms had started ۳ days earlier. Due to decreased consciousness and high blood sugar (BS=۵۱۰mg/dl), the patient was admitted to PICU ward with a possible diagnosis of complicated diabetic ketoacidosis. The patient diagnosed as new onset diabetes. The patient was treated with DKA protocol for ۶ days, which was withdrawn from DKA. The patient had brain edema in the PICU ward three times, treated with mannitol. The patient developed ۴-limb paresis during treatment then the right muscles force improved. Then the patient developed paraplegia then left hemiplegia (upper and lower extremity forces were ۴/۵ and ۳/۵respectively). In the following, the patient had mainly left hemiplegia. After exiting the PICU and transferring to the ward, the neuropathy was mainly paraparesis with greater severity in the left lower limb. The patient's DTR was also decreased on the left side. The patient was subsequently diagnosed with probable Stroke but no further pathologic findings (CT scan, MRI, MRV, and MRA) were found and color Doppler peripheral vascular ultrasound was normal. Therefore, the patient underwent EMG-NCV, suggesting acute and severe neuropathy of the left sciatic and ulnar nerves. The patient's upper limb force continued to improve and left lower limb force continued to improve too that the patient could walk a few steps. The patient was followed up on an outpatient basis and physiotherapy exercises and EMG-NCV were requested.Conclusion: The present study shows that peripheral neuropathy can be a rare complication of diabetic ketoacidosis, even in the first episode, although a completeneurologic examination is recommended in patients with diabetic ketoacidosis.

کلیدواژه ها:

Polyneuropathy ، Ketoacidosis ، Diabetes Mellitus Type ۱ ، Children.