Omar A, Nurani KM, Amolo P, Kadernani NM. Severe pediatric diabetic ketoacidosis with multi-organ dysfunction and complete recovery in a resource-limited setting: A case report. World J Transl Med 2026; 12(2): 120867 [DOI: 10.5528/wjtm.120867]
Corresponding Author of This Article
Najib Mohamed Kadernani, School of Medicine, University of Nairobi, Hospital Road, Upper Hill, Nairobi 30197-00100, Kenya. najib.ayub14@gmail.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
case-report
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Omar A, Nurani KM, Amolo P, Kadernani NM. Severe pediatric diabetic ketoacidosis with multi-organ dysfunction and complete recovery in a resource-limited setting: A case report. World J Transl Med 2026; 12(2): 120867 [DOI: 10.5528/wjtm.120867]
Anjumanara Omar, Department of Paediatrics and Child Health, University of Nairobi, Nairobi 30197-00100, Kenya
Khulud Mahmood Nurani, Najib Mohamed Kadernani, School of Medicine, University of Nairobi, Nairobi 30197-00100, Kenya
Prisca Amolo, Department of Paediatrics, Kenyatta National Hospital, Nairobi 30197-00100, Kenya
Author contributions: Omar A and Amolo P managed the patient and collected clinical data; Nurani KM performed the literature review; Nurani KM and Kadernani NM drafted the manuscript and clinically revised it.
AI contribution statement: No artificial intelligence tools were used in the preparation, writing, analysis, or revision of this manuscript.
Informed consent statement: Written informed consent was obtained from the patient’s parent/Legal guardian for publication of this case report and accompanying clinical details.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Najib Mohamed Kadernani, School of Medicine, University of Nairobi, Hospital Road, Upper Hill, Nairobi 30197-00100, Kenya. najib.ayub14@gmail.com
Received: March 11, 2026 Revised: May 26, 2026 Accepted: July 10, 2026 Published online: July 28, 2026 Processing time: 140 Days and 13 Hours
Abstract
BACKGROUND
Diabetic ketoacidosis (DKA) remains the most serious acute complication of type 1 diabetes mellitus (T1DM) in children and adolescents and is associated with significant morbidity and mortality when complicated by multi-organ failure.
CASE SUMMARY
We report the case of a 12-year-old girl with established T1DM who presented with profound DKA complicated by acute kidney injury (AKI) requiring haemodialysis, recurrent generalized seizures, cerebral oedema, and haemodynamic instability. Serial blood-gas analyses demonstrated extreme metabolic acidosis with persistently low bicarbonate levels despite standard therapy. Through aggressive multidisciplinary management involving paediatric intensive care, endocrinology, nephrology, neurology, and rehabilitation services, the patient achieved complete neurological, metabolic and renal recovery.
CONCLUSION
Pediatric DKA is life-threatening, with higher mortality in resource-limited settings due to complications like cerebral edema and AKI. Cerebral edema is the leading cause of death, requiring rapid treatment with mannitol or hypertonic saline. AKI is common, increases mortality and hospital stay, and may progress to chronic kidney disease. Early recognition of risk factors, prompt treatment, and close follow-up are critical to improving outcomes.
Core Tip: Severe diabetic ketoacidosis (DKA) in children can progress rapidly to life-threatening multi-organ dysfunction. We describe a 12-year-old girl with type 1 diabetes mellitus who developed acute kidney injury requiring haemodialysis, cerebral oedema, seizures, and haemodynamic instability during DKA. Despite cardiac arrest and prolonged intensive care, the patient achieved complete neurological and renal recovery through aggressive multidisciplinary management. This case highlights that early recognition of complications, timely critical care intervention, and coordinated specialty care can result in favourable outcomes even in severe paediatric DKA in resource-limited settings.
