Urinary stone in a 12-year-old adolescent with new-onset type 1 diabetes and diabetic ketoacidosis.

IF 1 Q4 ENDOCRINOLOGY & METABOLISM Clinical Pediatric Endocrinology Pub Date : 2022-01-01 Epub Date: 2022-06-08 DOI:10.1297/cpe.2021-0069
Kikumi Ushijima-Fuchino, Yuko Koga, Satoko Umino, Junko Nishioka, Junichiro Araki, Shuichi Yatsuga, Yushiro Yamashita
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Abstract

Dehydration and acidosis increase the risk for urinary stone formation. Urinary stones have been reported in three pediatric cases of diabetic ketoacidosis (DKA). A 24-h urine collection was performed for two of the three children. One patient had high urine sodium levels, while the other had low urine citrate excretion. We report the case of a 12-yr-old adolescent boy with urinary stones, new-onset type 1 diabetes mellitus (T1D), and DKA, excluding other metabolic disorders. After DKA was diagnosed, the patient received a 0.9% saline bolus and continuous insulin infusion. Hyperglycemia and ketoacidosis were well-controlled on the third day after admission. However, the patient developed abdominal pain radiating to the back. Urinary stones were suspected, and a urinalysis was performed. The patient's urine revealed significant elevation in red blood cells and calcium oxalate crystals. Computed tomography revealed a high-density left ureteric mass, suggestive of a urinary stone. Although both the previously reported pediatric cases involved metabolic diseases, additional tests in this patient excluded metabolic diseases other than T1D. DKA may be related to the formation of calcium oxalate crystals owing to dehydration and acidosis. Therefore, physicians should consider urinary stone formation in DKA patients.

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12岁青少年新发1型糖尿病合并糖尿病酮症酸中毒尿路结石1例。
脱水和酸中毒会增加尿路结石形成的风险。泌尿结石已报告3例小儿糖尿病酮症酸中毒(DKA)。对三名儿童中的两名进行了24小时尿液收集。一名患者尿钠水平高,而另一名患者尿柠檬酸排泄量低。我们报告一例12岁的青春期男孩,患有尿路结石、新发1型糖尿病(T1D)和DKA,不包括其他代谢紊乱。确诊DKA后,患者给予0.9%生理盐水灌注和持续胰岛素输注。入院后第3天高血糖和酮症酸中毒得到良好控制。然而,患者出现了向背部放射的腹痛。怀疑有尿路结石,并进行了尿液分析。病人尿液显示红细胞和草酸钙晶体明显升高。计算机断层显示左侧输尿管高密度肿块,提示尿路结石。虽然之前报道的两例儿童病例都涉及代谢性疾病,但该患者的其他检查排除了T1D以外的代谢性疾病。DKA可能与脱水和酸中毒引起的草酸钙晶体的形成有关。因此,医生应考虑DKA患者尿路结石的形成。
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来源期刊
Clinical Pediatric Endocrinology
Clinical Pediatric Endocrinology ENDOCRINOLOGY & METABOLISM-
CiteScore
2.40
自引率
7.10%
发文量
34
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