A 16-Year-Old Female with Diabetic Ketoacidosis, Diabetes Mellitus, Sepsis, and Constipation: A Case Report

Anggun Febry Kurniasari; Nuri Susanti

doi:10.60084/ijcr.v4i1.386

Authors

Anggun Febry Kurniasari General Practitioner, Petrokimia Gresik Hospital, Gresik, Indonesia
Nuri Susanti Department of Internal Medicine, Institute, Petrokimia Gresik Hospital, Gresik, Indonesia

DOI:

https://doi.org/10.60084/ijcr.v4i1.386

Keywords:

Diabetic ketoacidosis, Diabetes mellitus, Sepsis , Constipation

Abstract

Diabetic ketoacidosis (DKA) is a serious and potentially fatal complication of hyperglycemia, with a reported mortality rate of 2–5% depending on age. It commonly occurs in patients with uncontrolled insulin-treated diabetes mellitus (DM), especially when accompanied by severe underlying illness. Infection and insulin withdrawal are the two main triggers of DKA, with bacterial infections accounting for approximately 50% of cases, including urinary tract infections, pneumonia, and gastrointestinal conditions such as constipation. Constipation is more prevalent in diabetic patients with colonic neuropathy and may further complicate clinical outcomes. This case report presents a 16-year-old female with suspected new-onset type 1 DM who was admitted with DKA complicated by severe constipation and sepsis. The case highlights the complex interaction between poor glycemic control, infection, and systemic inflammatory responses in DKA. Diabetes mellitus can alter immune responses, infection patterns, and sepsis outcomes, contributing to increased morbidity and mortality. Diagnosing infection in patients with DKA remains challenging because both conditions share overlapping clinical and laboratory features, including fever, leukocytosis, and systemic inflammation. Early identification of bacterial infection is essential to ensure prompt and appropriate treatment while avoiding unnecessary antibiotic use that may contribute to antimicrobial resistance. This case report emphasizes the importance of early diagnosis of concurrent infection in patients with DKA to enable prompt management and improve clinical outcomes.

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References

Ehrmann, D., Kulzer, B., Roos, T., Haak, T., Al-Khatib, M., and Hermanns, N. (2020). Risk Factors and Prevention Strategies for Diabetic Ketoacidosis in People with Established Type 1 Diabetes., The Lancet. Diabetes & Endocrinology, Vol. 8, No. 5, 436–446. doi:10.1016/S2213-8587(20)30042-5.
Alourfi, Z., and Homsi, H. (2021). Precipitating Factors , Outcomes , and Recurrence of Diabetic Ketoacidosis at a University Hospital in Damascus, Vol. 5, No. 1, 11–15.
Ahmad, R., Narwaria, M., Singh, A., and Kumar, S. (2023). Detecting Diabetic Ketoacidosis with Infection : Combating a Life-Threatening Emergency with Practical Diagnostic Tools, 1–15.
Umpierrez, G. E., Davis, G. M., ElSayed, N. A., Fadini, G. P., Galindo, R. J., Hirsch, I. B., Klonoff, D. C., McCoy, R. G., Misra, S., Gabbay, R. A., Bannuru, R. R., and Dhatariya, K. K. (2024). Hyperglycemic Crises in Adults With Diabetes: A Consensus Report, Diabetes Care, Vol. 47, No. 8, 1257–1275. doi:10.2337/dci24-0032.
Blanchard, F., Charbit, J., Van der Meersch, G., Popoff, B., Picod, A., Cohen, R., Chemouni, F., Gaudry, S., Bihan, H., and Cohen, Y. (2020). Early Sepsis Markers in Patients Admitted to Intensive Care Unit with Moderate-to-Severe Diabetic Ketoacidosis., Annals of Intensive Care, Vol. 10, No. 1, 58. doi:10.1186/s13613-020-00676-6.
Kenny, G. P., Sigal, R. J., and McGinn, R. (2016). Body Temperature Regulation in Diabetes., Temperature (Austin, Tex.), Vol. 3, No. 1, 119–145. doi:10.1080/23328940.2015.1131506.
Diaz S, Bittar K, Hashmi MF, et al. (2026). Constipation., StatPearls Publishing.
Bharucha, A. E., and Lacy, B. E. (2020). Mechanisms, Evaluation, and Management of Chronic Constipation., Gastroenterology, Vol. 158, No. 5, 1232-1249.e3. doi:10.1053/j.gastro.2019.12.034.
Marathe CS, Rayner CK, Wu T, et al. (2024). Gastrointestinal Disorders in Diabetes.
De Fano, M., Baluganti, S., Manco, M., Porcellati, F., Fanelli, C. G., and Bassotti, G. (2025). The Sweet Side of Constipation: Colonic Motor Dysfunction in Diabetes Mellitus., Nutrients, Vol. 17, No. 19. doi:10.3390/nu17193038.
Musey, V. C., Lee, J. K., Crawford, R., Klatka, M. A., McAdams, D., and Phillips, L. S. (1995). Diabetes in Urban African-Americans. I. Cessation of Insulin Therapy Is the Major Precipitating Cause of Diabetic Ketoacidosis., Diabetes Care, Vol. 18, No. 4, 483–489. doi:10.2337/diacare.18.4.483.
Ramos, E. L., Dayan, C. M., Chatenoud, L., Sumnik, Z., Simmons, K. M., Szypowska, A., Gitelman, S. E., Knecht, L. A., Niemoeller, E., Tian, W., and Herold, K. C. (2023). Teplizumab and β-Cell Function in Newly Diagnosed Type 1 Diabetes., The New England Journal of Medicine, Vol. 389, No. 23, 2151–2161. doi:10.1056/NEJMoa2308743.
Holt, R. I. G., DeVries, J. H., Hess-Fischl, A., Hirsch, I. B., Kirkman, M. S., Klupa, T., Ludwig, B., Nørgaard, K., Pettus, J., Renard, E., Skyler, J. S., Snoek, F. J., Weinstock, R. S., and Peters, A. L. (2021). The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)., Diabetologia, Vol. 64, No. 12, 2609–2652. doi:10.1007/s00125-021-05568-3.