<![CDATA[Diabetic ketoacidosis (DKA) is a potentially life-threatening condition that can happen as a complication of diabetes mellitus (DM) or as one of the first manifestations of type 2 DM. DKA treatment involves the use of fluids to treat the patient's dehydration and the administration of intravenous insulin to stop the production of ketones in the body. The two-bag system allows for the adjustment of the rate of administration of glucose and insulin separately. To describe the management of severe diabetic ketoacidosis using high-dose insulin and a two-bag system in a child with suspected ketosis-prone type 2 diabetes mellitus. This case report describes a 12-year-old boy who presented to the Emergency Department of Panti Wilasa Dr. Cipto Hospital, Semarang, with severe diabetic ketoacidosis and suspected ketosis-prone type 2 diabetes mellitus. Clinical and laboratory data, treatment, and outcomes were retrospectively collected from medical records and descriptively reviewed. A 12-year-old boy presented with symptoms of vomiting, dehydration and Kussmaul breathing. Physical examination revealed obesity (BMI 34.16 kg/m²), abdominal obesity, hypertension and acanthosis nigricans. Blood tests revealed blood glucose levels of 459 mg/dL, HbA1c levels of 10.3%, ketonuria, a pH level of 6.87 and HCO₃⁻ levels of 1.1 mmol/L, showing a diagnosis of diabetic ketoacidosis with suspected ketosis-prone Type 2 diabetes mellitus. The patient was treated with fluid replacement, continuous intravenous insulin at doses up to 5 IU/hour, antibiotics and a two-bag system. The patient made a full recovery without any complications and was started on basal-bolus insulin therapy. In this case, a child who was severely obese and had marked insulin resistance required a relatively high dose of insulin to manage the severe DKA. However, by carefully monitoring the patient's blood glucose, electrolytes, fluid balance and neurological status, the high-dose insulin therapy along with a two-bag system was successfully implemented without any complications such as cerebral oedema.]]>
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