Hypophosphatemia-induced seizure in a child with diabetic ketoacidosis

Area of Science:

• Pediatric Endocrinology
• Critical Care Medicine
• Neurology

Background:

• Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes, often requiring intensive care management.
• Treatment protocols for DKA involve fluid resuscitation, electrolyte correction, and insulin therapy.
• Electrolyte imbalances, particularly hypophosphatemia, can occur during DKA management.

Observation:

• A 1-year-old boy with type 1 diabetes presented with DKA, hyperglycemia, and dehydration.
• Despite standard DKA treatment, the patient developed tonic-clonic seizures, apnea, and cardiorespiratory arrest.
• Severe hypophosphatemia (serum phosphorus 1.0 mg/dL) was identified as the likely cause of the neurological and hemodynamic complications.

Findings:

• Intravenous phosphate replacement led to significant improvement in the patient's neurological and hemodynamic status.
• No other underlying cause for the cerebral complications was identified.
• The patient recovered without neurological sequelae and was discharged.

Implications:

• Severe hypophosphatemia is a critical, potentially life-threatening complication of DKA treatment that requires prompt recognition and management.
• Routine monitoring of serum phosphorus levels and early phosphate supplementation should be considered in pediatric DKA management to prevent neurological complications.
• This case underscores the importance of vigilant electrolyte monitoring in critically ill children with DKA.