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Theophylline intoxication mimicking diabetic ketoacidosis in a child
M Polak1, M A Rolon, A Chouchana
1Service d'Endocrinologie Pédiatrique et Métabolique, Hôpital Robert Debre, Paris, France. michel.polak@rdb.ap-hop-paris.fr
Insights
Accidental theophylline poisoning in a child mimicked diabetic ketoacidosis, presenting with vomiting and high blood sugar. The condition resolved with reduced insulin, highlighting the importance of considering drug toxicity in similar cases.
Area of Science:
- Pediatrics
- Toxicology
- Endocrinology
Background:
- Diabetic ketoacidosis (DKA) is a serious complication of diabetes characterized by hyperglycemia, ketosis, and metabolic acidosis.
- Accidental drug poisoning can present with symptoms that mimic other medical conditions, posing diagnostic challenges.
Observation:
- A 5-year-old boy presented with symptoms suggestive of DKA, including abdominal pain, nausea, and vomiting of blood.
- Initial treatment for DKA with insulin led to a rapid normalization of blood glucose, with decreasing insulin requirements.
- Persistent tachycardia without dehydration prompted further investigation into alternative diagnoses.
Findings:
- The child was diagnosed with accidental theophylline poisoning, which caused hyperglycemia and masked DKA symptoms.
- Salicylate intoxication was ruled out, and theophylline was identified as the causative agent.
- The patient showed no signs of pre-diabetes or diabetes upon follow-up for four years.
Implications:
- Theophylline poisoning can transiently mimic diabetic ketoacidosis, necessitating a broad differential diagnosis in pediatric cases.
- Clinicians should consider drug-induced hyperglycemia, especially when insulin requirements decrease rapidly.
- Prompt recognition and management of theophylline toxicity are crucial to prevent severe complications.
Abstract:
A 5-year-old boy presented with abdominal pain, nausea and vomiting of blood. Twelve hours after admission, "diabetic ketoacidosis" was diagnosed on the basis of elevated glycaemia, glycosuria, ketonuria and a low bicarbonate blood level, which led to treatment with fluids and regular insulin infusion. Over a 36-hour period, insulin was progressively decreased and finally stopped because of the rapid fall and normalization of blood glucose concentration. Drug poisoning was suspected on the basis of persistent tachycardia in the absence of other signs of dehydration. Salicylate intoxication was excluded, and theophylline was finally incriminated. This compound, used by adults in the child's home, had caused accidental theophylline poisoning, mimicking diabetic ketoacidosis. Pre-diabetic immune markers were repeatedly negative, and no diabetes has developed after four years of follow-up. Thus, the transient increase in blood glucose was not related to a pre-diabetic status. A diagnosis of masked theophylline poisoning should be considered in similar situations involving a rapid decrease of insulin requirements.