Diabetic Ketoacidosis and Severe Acute Necrotizing Pancreatitis in a Female Child: A Clinical Quandary

Abstract

The coexistence of diabetic ketoacidosis (DKA) and acute pancreatitis presents a rare and challenging clinical conundrum, wherein one disorder may lead to the other, creating a vicious cycle of metabolic and inflammatory insult. We report the case of a 9-year-old overweight girl who presented with severe epigastric pain, vomiting, polyuria, and altered sensorium. Laboratory evaluation revealed hyperglycemia, metabolic acidosis, positive urine ketones, and markedly raised pancreatic enzyme levels, consistent with DKA and acute pancreatitis. Normal glycated hemoglobin (HbA1c) argued against preexisting diabetes mellitus. Imaging demonstrated diffuse pancreatic enlargement with extensive necrotizing collections replacing the parenchyma. Despite aggressive management with insulin infusion, intravenous fluids, broad-spectrum antibiotics, and multiple pig-tail drain insertions for peripancreatic abscesses, the child developed disseminated sepsis and multiorgan failure and succumbed after a prolonged hospital stay. The simultaneous occurrence of DKA and necrotizing pancreatitis in a previously nondiabetic child is exceedingly rare. HbA1c remains a pivotal marker in distinguishing stress-induced hyperglycemia from preexisting diabetes. This case underscores the catastrophic synergy of these two conditions and highlights the need for early recognition, strict glycemic control, and a multidisciplinary approach for ensuring optimal outcomes in acute pancreatitis with DKA.