Complicated Presentation of Diabetic Ketoacidosis (DKA) with Concurrent Infection

Abstract

A 17-year-old male with a diagnosis of type-1 diabetes since the age of 7 was treated with insulin. This case report he had been referred from Abbottabad with severe vomiting, dehydration, and a generalized vesicular rash suggestive of chickenpox. He presented in a state of DKA, overlapping with chickenpox infection. DKA was managed with liberal fluid replacement, intravenous insulin therapy, and strict electrolyte management. Treatment of the chickenpox infection involved intravenous acyclovir and supportive care. An ongoing assessment was necessary, with the management plan altered to manage the metabolic derangements associated with DKA and respiratory support given co-existing viral infection. After various days, his metabolic parameters were stabilized, and you could see that he felt better, so we managed to discharge him with indications of outpatient follow-up. This case highlights the difficulties in treating DKA during concomitant infections and stresses the importance of a combined approach and close monitoring.