ABSTRACT 286

Abstract

Background and aims: DKA is not a rare admission diagnosis for PICU, and its treatment is quite standard. Here we report a new onset insulin dependent diabetic child unresponsive to regular management. Results: A 6-year-old girl was admitted to the Pediatric Intensive Care Unit (PICU) due to severe DKA and altered level of consciousness. Her past medical history was unremarkable except for polyuria and polydipsia since one week. She was tachycardic, tachypneic and her peripheral perfusion was compromised. She was intubated due to further deterioration of her breathing and mentation. Her cranial computed tomography did not reveal brain edema. Her anion gap normalized after 16 hours of insulin, however her acidosis was refractory due to hyperchloremia. Her laboratory values are given in Table 1. Supportive therapy was continued with mechanical ventilation, inotropic support for hypotension, insulin infusion, short term bicarbonate infusion and careful fluid and electrolyte management. Continuous venovenous hemodialysis (CVVHD) was started due to intractable hyperosmolar coma. Hypernatremia was corrected by a rate of 0.68 mEq/L per hour. Within 38 hours of CVVHD serum sodium and creatinine levels normalized, inotropic medications were stopped. She woke up appropriately, and was extubated shortly thereafter on the 5th day. She was discharged 5 days later from the unit with no sequela.Table: No title available.Conclusions: The need for renal replacement therapies is extremely rare in children with DKA. To our knowledge, this is the youngest patient who was supported with CVVHD and mechanical ventilation for refractory hyperosmolar coma with full neurological recovery.