A rare diabetes ketoacidosis in combined severe hypernatremic hyperosmolarity in a new-onset Asian adolescent with type I diabetes.

A 13-year-old Asian boy presented with an 8 h history of lethargy and vomiting. He had a 3-week history of polyuria, polydipsia and a 6 kg weight loss over a period of 1 month. Fluid intake prior to admission was over 6 L of sports drinks and cola per day. Initial biochemical findings were as follows: plasma glucose 1351 mg/dL, serum sodium 154 mEq/L, serum osmolarity 425 mOsm/L, arterial blood pH 6.96 and urine ketone of 3+. He was treated with intensive fluid resuscitation and an insulin infusion. He completely recovered without any neurological deficits. Severe hypernatremia is rare in diabetic ketoacidosis (DKA) but was exhibited in this case. Excess intake of carbonated carbohydrate-rich beverages may exacerbate the initial severe presentation of type I diabetes mellitus (T1DM). To the best of our knowledge, this is the first case of an Asian child with DKA combined with severe hypernatremic hyperosmolarity at onset of T1DM.