Objectives Abdominal pain is a common presentation in patients of diabetic ketoacidosis (DKA). However, this pain generally resolves with resolution of dehydration and acidosis. Persistence of abdominal pain even after resolution of ketosis and acidosis should warrant careful reassessment to find evidence of sepsis and concomitant abdominal pathology. Case presentation We report a rare case of type 1 diabetes mellitus in a 15 year old girl diagnosed 6 months ago who presented with mild DKA (pH 7.24, HCO3 − 13.5 mmol/L). Her hospital course was extremely stormy and despite best of our efforts she succumbed due to colonic ischemia and perforation peritonitis. Conclusions A high index of suspicion for gut ischemia or perforation should be kept if DKA is associated with septic shock and there is suboptimal response to standard treatment. Mesenteric ischemia can occur in pediatric patients even with mild DKA having very poor diabetes control.

中文翻译：

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从忽视到危险：糖尿病酮症酸中毒导致 1 型糖尿病少女结肠坏死和穿孔

目的 腹痛是糖尿病酮症酸中毒 (DKA) 患者的常见症状。然而，这种疼痛通常会随着脱水和酸中毒的缓解而消失。即使在酮症和酸中毒消退后，腹痛仍然持续，应仔细重新评估，以找到脓毒症和伴随腹部病理的证据。病例介绍 我们报告一例罕见的 1 型糖尿病病例，患者为一名 6 个月前诊断出的 15 岁女孩，患有轻度 DKA（pH 7.24，HCO3 -13.5 毫摩尔/升）。她的住院过程非常艰难，尽管我们尽了最大努力，她还是因结肠缺血和穿孔性腹膜炎而去世。结论 如果 DKA 与感染性休克相关并且对标准治疗的反应不佳，则应高度怀疑肠道缺血或穿孔。即使患有轻度 DKA 且糖尿病控制非常差的儿科患者也可能发生肠系膜缺血。