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| CASE REPORT |
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| Year : 2014 | Volume
: 9
| Issue : 2 | Page : 91-92 |
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Acute psychosis following diabetic ketoacidosis in an 11-year-old, management challenges in a resource-limited setting
Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| Date of Web Publication | 9-Dec-2014 |
Correspondence Address:
Ibrahim Aliyu
Department of Paediatrics, National Post-Graduate Medical College, Aminu Kano Teaching Hospital, Bayero University, Kano
Nigeria
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DOI: 10.4103/1858-5000.146583 
Diabetes mellitus (DM) is the most common endocrine disorder in children and type 1 DM is the most common; however increasing incidence of type 2 DM is being reported, especially in western societies. Occurrence of psychiatric disorders has been associated with type 2 DM but is rare in those with type 1 DM; therefore the case of an 11-year-old girl who was treated for diabetic ketoacidosis, but suddenly developed acute psychotic symptoms shortly after regaining consciousness is reported. Atypical antipsychotic medications were avoided in this case for concerns of their risk of causing abnormal glucose metabolism. Keywords: Acute psychosis, diabetic ketoacidosis, type 1 diabetes mellitus
How to cite this article:
Aliyu I. Acute psychosis following diabetic ketoacidosis in an 11-year-old, management challenges in a resource-limited setting
. Sudan Med Monit 2014;9:91-2 |
| Introduction | |  |
Diabetes mellitus (DM) is the commonest endocrine disorder in children. [1] Though type 1 DM is the commonest, increasing incidence of childhood obesity especially in industrialized societies has resulted in an upsurge of type 2 DM. [2],[3] Type 1 DM classically present with polyuria, polydipsia, polyphagia, and weight loss however its initial presentation may be diabetic ketoacidosis (DKA). There is an established relationship between type 2 DM and psychotic disorders and there is also the risk of DM [4] related adverse event from the use of some of the atypical antipsychotic drugs [5],[6],[7]] but the association of type 1 DM, DKA with psychosis is a rare event, therefore the case of an 11-year-old girl is reported.
| Case report | | |
An 11-year-old recently diagnosed type 1 DM patient who was managed for DKA suddenly developed visual hallucination, irrational talks, aggressive behavior, with confused thought and speech after regaining consciousness from DKA; she had no past or family history of psychiatric disorder, no history of fever or head trauma. The physical examinations were not remarkable except for the poor cohesion of thoughts at that point in time. The electrolyte, urea and creatinine, thyroid function test were essentially normal, and the blood and urine glucose were normal at the time of psychosis. Based on these, the diagnosis of post-DKA psychosis was made. She was placed on chlorpromazine (CPZ) at 1 mg/kg/dose and she improved significantly; she is currently being follow-up and no record of relapse was recorded for the past 6-month.
| Discussion | | |
The exact link between schizophrenia and type 2 DM is not completely known; however possible genetic factors may be contributory. However, the link between type 1 DM and schizophrenia has not been established. Acute psychosis may be associated with metabolic, structural neurologic disorders, and febrile illnesses such as malaria and typhoid fever but the exact mechanism is not clear; [8],[9] our patient had type 1 DM; and why she developed psychosis is not clear, the metabolic changes associated with DKA such as changes in serum osmolality and electrolytes results in changes which could alter the body's homeostasis resulting in fluid shift in the brain which may present with neurologic symptoms; it is a transit event which resolves with treatment of the acute metabolic insult.
However the serum glucose, sodium and potassium were normal at the time of psychosis in the index case, which makes it difficult to completely attribute her symptoms to changes in serum glucose and electrolytes.
Atypical antipsychotic drugs are the cornerstone in the acute management of psychosis however there are concerns of its association with the development of dyslipidemia, hyperglycemia, ketoacidosis and DM; [10] this compounded her management because they were avoided in the index case; however CPZ are effective in controlling the positive symptoms in psychosis such as hallucination, aggression, delusion; and the index case responded to treatment. Though, CPZ has limitation with control of negative symptoms such as apathy, more so there is an associated risk of weight gain, but these were not noticed in the index case. [11] Despite these limitations, she made remarkable improvement and has remained symptom-free for the past 6-month.
| Conclusion | | |
Type 1 DM with DKA may be associated with acute psychosis though the exact mechanism is not known; unlike in type 2 DM, the possibility of these psychiatric symptoms resulting from metabolic derangement arising from DKA cannot be completely ruled out-which is likely to be a transit event; however long-term follow-up of such category of cases is still needed to exclude the possibility of chronicity.
| References | | |
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