Mortality patterns among critically ill children in a pediatric intensive care unit of a developing country

treated in line of DKA with parenteral fluid, electrolytes, and insulin infusion that resulted in an improvement in hyperglycemia, but the persistence of HAGMA and lack of improvement of neurologic status.Urinary organic acid analysis revealed increased methylmalonic acid levels.He also had hyperhomocysteinemia and homocystinuria in the presence of normal Vitamin B 12 levels.There was some improvement in the neurologic status and metabolic parameters after treatment with low-protein diet, vitamin B12, folic acid, and L-carnitine, but he succumbed to polymicrobial nosocomial sepsis.Six of these nine (2/3 rd ) reported cases of MMA presented as DKA died, without any information on long term outcome of those who survived.[11] The unusual presentation of MMA as DKA reminds us of the wide clinical spectrum of inborn errors of metabolism.In very young patients, who present with DKA and on being treatment with fluid and insulin show rapid improvement in hyperglycemia and/or poor response in metabolic acidosis or neurological status should be worked up for organic acidemia in particular MMA.