Severe pediatric diabetic ketoacidosis with multi-organ dysfunction and complete recovery in a resource-limited setting: A case report

Table 1 Renal function

	Reference range	D3	D4	D5	D6	D7	D8	D12	D19	D22	D24	D29	D31	D34
Urea (mmol/L)	1.8-5.2	14.2	19.9	24.7	22.9	20.5	13.9	31.8	13.7	7.2	5.3	6.7	4.7	5.0
Creatinine (µmol/L)	20-70	297	557	576	500	470	371	666	457	290	194	104	83	74

Table 2 Electrolyte changes

Parameter (unit)	Reference range	D1	D2	D3	D4	D5	D6	D7	D8	D9	D12	D19	D24	D29
Na (mmol/L)	136-145	136	147	143	139	143	138	134.4	135	141	137	139	141	136
K (mmol/L)	3.5-5.5	3.9	3.8	4.2	3.5	3.2	3.3	4.2	3.9	2.9	4.0	5.0	3.2	4.4
Cl (mmol/L)	96-108	115	128	133	126	119	112	103	104	106	103	102	104	98

Table 3 Timeline of treatment

Time	Treatment
Day 1	Admission to ICU with severe DKA, shock severe acidosis and ketonuria
Day 2	Standard DKA management
Day 3	Worsening oliguria progressing to anuria
	Care was transferred under specialists
	Hemodialysis indicated
Day 4-6	Two episodes of generalized tonic clonic seizures
	Neuroimaging indicated and cerebral oedema was noted
	Mannitol, hypertonic saline and levetirecetam
Day 6	Cardiac arrest secondary to metabolic derangements and multi-organ dysfunction
	Successful resuscitation and the patient was intubated and mechanically ventilated
Day 7-10	Gradual neurological, renal, and metabolic improvement. Vasopressor and ventilatory support successfully weaned
Day 10	Transferred from ICU to paediatric ward
Day 11-37	Continued renal recovery, physiotherapy, nutritional rehabilitation and multidisciplinary follow up
Day 37	Discharged home in stable condition with complete neurological recovery and improving renal function

ICU: Intensive care unit; DKA: Diabetic ketoacidosis.