Hemolysis During Diabetic Ketoacidosis Revealing Glucose-6-Phosphate Dehydrogenase Deficiency in New-Onset Type 1 Diabetes Mellitus: A Case Report
Aranza Cortés Jáuregui1*, Gina Pinilla Santana1
1Department of Pediatrics, Curaçao Medical Center, Curaçao.
*Corresponding Author: Aranza Cortés Jáuregui, Department of Pediatrics, Curaçao Medical Center, Curaçao.
https://doi.org/10.58624/SVOAPD.2026.05.007
Received: March 25, 2026
Published: April 15, 2026
Citation: Jáuregui AC, Santana GP. Hemolysis During Diabetic Ketoacidosis Revealing Glucose-6-Phosphate Dehydrogenase Deficiency in New-Onset Type 1 Diabetes Mellitus: A Case Report. SVOA Paediatrics 2026, 5:2, 56-60. doi: 10.58624/SVOAPD.2026.05.007
Abstract
Background: Type 1 diabetes mellitus (T1DM) frequently presents in childhood with diabetic ketoacidosis (DKA), a potentially life-threatening complication. Hemolysis during DKA treatment is uncommon but may indicate an underlying condition such as glucose-6-phosphate dehydrogenase (G6PD) deficiency—a genetic enzymatic disorder that predisposes red blood cells to oxidative stress.
Case presentation: We report the case of a previously healthy 16-year-old male from Curaçao who presented with a one-week history of malaise, vomiting, polydipsia, polyuria, weight loss, and hematuria. He exhibited severe dehydration and Kussmaul respiration. Laboratory findings revealed marked hyperglycemia (394.5 mg/dL), severe metabolic acidosis and ketonuria, consistent with a diagnosis of new-onset T1DM with severe DKA. He was admitted to the Pediatric Intensive Care Unit and managed with intravenous fluids and insulin. Within 24 hours, ketosis had resolved, allowing transition to a subcutaneous insulin regimen (Degludec and Aspart). During admission, he developed progressive jaundice with laboratory findings of unconjugated hyperbilirubinemia, falling hemoglobin levels, and positive hemolysis markers. G6PD deficiency was confirmed through additional testing.
Conclusion: This case highlights the importance of considering G6PD deficiency in pediatric patients with DKA who develop unexplained hemolysis or jaundice. Early recognition can help guide supportive care and avoid exposure to oxidative triggers during diabetes management.
Keywords: Type 1 Diabetes Mellitus, Glucose-6-Phosphate Dehydrogenase Deficiency, Diabetes Ketoacidosis, Hemolysis.