Hypertension Despite Dehydration in an Adolescent with Diabetic Ketoacidosis

Alphonsus N Onyiriuka, Promise Monday, Chinwe A Oguejiofor


In general, information on blood pressure changes in diabetic ketoacidosis in paediatric population is very scarce. Our aim was to report a case of severe DKA in an adolescent girl who unexpectedly had hypertension rather than hypotension.
A 17-year-old girl presented in our Children’s Emergency Unit with complaints of excessive eating for 6 weeks, excessive urination for 2 weeks, fever for 1 week, vomiting for 4 days, difficulty with breathing for one day and unresponsiveness to calls for 3 hours. She had moderated to severe dehydration but no hypotension. Laboratory findings included hyperglycaemia (random blood glucose 20.8 mmo/L; 347 mg/dl), acidosis (serum bicarbonate 5 mmol/L),  ketonuria 2+; glycosuria 2+, and urine  specific gravity of 1.015. At admission, the blood pressure was 100/60 mmHg but progressively rose to 140-180/80-100 mmHg by the third day from admission. A significant hypertension can occur in children and adolescents admitted for severe DKA despite the presence of dehydration. Therefore, the attending physician should be aware of this possibility.


diabetic ketoacidosis; dehydration; hypertension


Santhanam I. Pediatric emergency medicine course. New Delhi: Jaypee Brothers Medical Publishers Ltd; 2008. p. 145-55.

Roche EF, Menon A, Gill D, Hoey H. Clinical presentation of type 1 diabetes. Pediatr Diabetes. 2005;6:75-8.

Deeter KH, Roberts JS, Bradford H, et al. Hypertension despite dehydration during severe pediatric diabetic ketoacidosis. Pediatr Diabetes. 2011;12(4):295-301.

Glaser N, Barnett P, McCaslin I, et al. Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. N Engl J Med. 2001;344:264-9.

Brown FK. Cardiovascular effects of acutely raised intracranial pressure. Am J Physiol. 1956;185:510-4.

National High Blood Pressure Education Program Working Group on High B lood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 Suppl):555-76.

Ralston M, editors. Pediatric advanced life support provider manual. American Heart Association, Subcommittee on Pediatric Resuscitation; Dallas: 2006. p. 61.

Flynn JT, Tullus K. Severe hypertension in children and adolescents: pathophysiology and treatment. Pediatr Nephrol. 2009;24:1101-12.

Umpierrez GE, Di Girolamo M, Tuvlin JA, et al. Differences in metabolic and hormonal milieu in diabetic- and alcohol-induced ketoacidosis. J Crit Cre. 2000;15(2):52-9.

Stentz FB, Umpierrez GE, Cuervo R, Kitbchi AE. Proinflammatory cytokines , markers of caediovascular risks, oxidative stress and lipid perioxidation in patients with hyperglycemic crises. Diabetes. 2004;53(8):2079-86.

Durr JA, Hoffman WH, Hensen AH, et al. Osmoregulation of vasopressin in diabetic ketoacidosis. Am J Physiol. 1990;259(5 Pt I):E723-E728.

Tulassay T, Rascher W, Korner A, Miltenyi M. Atrial natriuretic peptide and other vasoactive hormones during treatment for ketoacidosis in children. J Pediatr. 1987;111(3):329-34.

Roberts JS, Vavilala MS, Schenkman KA, et al. Cerebral hyperemia and impaired cerebral autoregulation associated with diabetic ketoacidosis in critically ill children. Crit Care Med. 2006;34:2217-23.

Glaser NS, Wootton-Gorges SL, Marcin JP, et al. Mechanism of cerebral oedema in children with diabetic ketoacidosis. J Pediatr. 2004;145:164-71.

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