Infantile Tremor Syndrome (ITS) Presenting as Diabetic Ketoacidosis (DKA): Correspondence
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To the Editor : We have read the recently published article titled “Infantile tremor syndrome (ITS) presenting as diabetic ketoacidosis (DKA)” by Sugumar and colleagues  with great interest. Authors presented a 12-mo-old boy who presented with diabetic ketoacidosis (DKA) and later was diagnosed to have infantile tremor syndrome (ITS).
The presented child had pre-existing global delay (developmental age < 3 mo), hyperglycemic ketoacidosis, pancytopenia, and signs and symptoms of vitamin B12 deficiency. Although, inborn errors of metabolisms (IEMs) usually present with hypoglycemic ketoacidosis but there are several IEMs which may have hyperglycemic ketoacidosis namely organic acidemia [methylmalonic acidemia (MMA), propionic acidemia (PA), isovaleric academia], β-ketothiolase deficiency, thiamine-responsive megaloblastic anemia, mitochondrial respiratory chain disorders, and holocarboxylase synthetase deficiency [2, 3]. Accumulation of toxic substances in pancreatic gland, disturbed...