1 - Cirurgia Pediátrica, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
- Oral presentation - 8ª reunião da EUSPP e 23º congresso da SPCP
Introduction: Diabetic ketoacidosis (DKA) is a serious complication of diabetes and can be the first manifestation of type 1 diabetes. There is a significant overlap between DKA and sepsis since impairment of the immune and metabolic system caused by diabetes increase the sepsis risk and its severity.
Clinical case: A 14-years-old girl presented to our emergency department (ED) with a 15 day history of a sacroccocigeal lesion, 5kg weight loss, polydipsia and progressive dyspnea. The patient was previously observed in a peripheral hospital ED, being discharged with a sinus pilonidal infection and anxiety disorder diagnosis. The patient presented to us dehydrated, polypneic and with malperfusion. Blood gas work showed metabolic acidosis with high glucose, lactate and ketone levels; venous blood work showed leukocytosis and high CRP levels. The diagnosis of DKA was established and the patient was transferred to the ICU. Hydration, insulin and metabolic compensation were initiated as well as antibiotic therapy due to the SP infection and necrosis, and debridement of necrotic tissue was performed. After 3 days the patient was in septic shock - shortness of breath with need of oxygen support, hypotension requiring dopaminergic support, oliguria, and neurological impairment - with worsen inflammatory signs were noted around the sinus area. Blood work showed leukocytosis, high CRP and procalcitonin levels, renal dysfunction and severe anemia. Meropenem was initiated and sinusectomy was performed. After patient stabilization, a strategy of vacuum therapy and hyperbaric chamber was established until the wound closing with a Limberg flap. The hyperbaric chamber therapy was maintained until complete healing.
Conclusion: This clinical case shows how a usually innocent infection can represent a medical and surgical challenge, leading to a life-threatening sepsis in poorly controlled type 1 diabetic patients.
Palavras Chave: sepsis, type 1 diabetis, sinus pilonidalis