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Dka Causing Aki

Acute Kidney Injury As A Severe Complication Of Diabetic Ketoacidosis

Acute Kidney Injury As A Severe Complication Of Diabetic Ketoacidosis

Background: Diabetic ketoacidosis (DKA) in children and young adults carries significant morbidity and mortality relating to complications such as cerebral oedema. Acute kidney injury (AKI) is a rare but potentially fatal complication of DKA. We present three cases of DKA complicated by AKI. Case 1: A 9-year-old girl presented with severe DKA at diagnosis. She was treated with intravenous fluids and insulin as per protocol. She had oliguria and haematuria 36 h after admission. She was hypertensive with evidence of enlarged kidneys on ultrasound (USS). She was transferred to the renal unit where she needed two cycles of hemodialysis before making full recovery. Case 2: A 14-year-old girl presented with severe DKA and altered consciousness at diagnosis. She developed oliguria 24 h after starting treatment for DKA. USS of abdomen showed enlarged kidneys. Her renal function improved with haemofiltration and recovered fully by 1 week. Case 3: 17-year-old girl with poorly controlled type 1 diabetes presented with severe DKA. She showed evidence of AKI with very high plasma creatinine, oliguria and low plasma phosphate. She was managed conservatively with individualised fluid plan and phosphate supplementation with recovery in 7 days. Conclusion: Patients with severe DKA can develop AKI due to a number of possible causes, hypovolaemia being the most likely primary cause. Appropriate management of hypovolemia and electrolyte disturbance in these patients can be very challenging. These cases highlight the importance of early recognition of AKI (rising plasma creatinine, oliguria, haematuria) and discussion with paediatric nephrologist to formulate individualised fluid therapy in order to prevent deterioration in renal function. It is uncertain if recent modification in fluid man Continue reading >>

(pdf) Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

(pdf) Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

pital Saint-Roch, CHU de Nice, Nice, France, 2IRCAN, Faculte 3Laboratoire de Biochimie, CHU de Nice, Nice, France Acute kidney injury is a classical complication of diabetic ketoacidosis. However, to the best of our knowledge, no study has reported the incidence and characteristics of acute kidney injury since the consensus definition was issued. Retrospective study of all cases of severe diabetic ketoacidosis hospitalised consecutively in a medical surgical tertiary ICU during 10 years. Patients were dichotomised in with AKI and without AKI on admission according to the RIFLE classification. Clinical and biological parameters were compared in these populations. Risk factors of presenting AKI on Ninety-four patients were included in the study. According to the RIFLE criteria, 47 patients (50%) presented acute kidney injury on admission; most of them were in the risk class (51%). At 12 and 24 hours, the percentage of AKI patients decreased to 26% and 27% respectively. During the first 24 hours, 3 patients needed renal replacement therapy. Acute renal failure on admission was associated with a more advanced age, SAPS 2 and more severe biological impairments. Treatments were not different between groups except for insulin infusion. Logistic regression found 3 risk factors of presenting AKI on admission: age (odds ratio 1.060 [1.0201.100], p,0.01), blood glucose (odds ratio 1.101 [1.0391.166], p,0.01) and serum protein (odds ratio 0.928 [0.8650.997], p = 0.04). Acute kidney injury is frequently associated with severe diabetic ketoacidosis on admission in ICU. Most of the time, this AKI is transient and characterised by a volume-responsiveness to fluid infusion used in DKA treatment. Age, blood glucose and serum protein are associated to the occurrence of AKI on ICU admissi Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Diabetic ketoacidosis is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. DKA occurs mostly in type 1 diabetes mellitus (DM). It causes nausea, vomiting, and abdominal pain and can progress to cerebral edema, coma, and death. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia. Diabetic ketoacidosis (DKA) is most common among patients with type 1 diabetes mellitus and develops when insulin levels are insufficient to meet the body’s basic metabolic requirements. DKA is the first manifestation of type 1 DM in a minority of patients. Insulin deficiency can be absolute (eg, during lapses in the administration of exogenous insulin) or relative (eg, when usual insulin doses do not meet metabolic needs during physiologic stress). Common physiologic stresses that can trigger DKA include Some drugs implicated in causing DKA include DKA is less common in type 2 diabetes mellitus, but it may occur in situations of unusual physiologic stress. Ketosis-prone type 2 diabetes is a variant of type 2 diabetes, which is sometimes seen in obese individuals, often of African (including African-American or Afro-Caribbean) origin. People with ketosis-prone diabetes (also referred to as Flatbush diabetes) can have significant impairment of beta cell function with hyperglycemia, and are therefore more likely to develop DKA in the setting of significant hyperglycemia. SGLT-2 inhibitors have been implicated in causing DKA in both type 1 and type 2 DM. Continue reading >>

Diabetic Ketoacidosis Associated With Acute Kidney Injury

Diabetic Ketoacidosis Associated With Acute Kidney Injury

Diabetic Ketoacidosis Associated With Acute Kidney Injury A new Journal of American Medical Association article has shown that there is a high rate of occurrence of acute kidney injury (AKI) in children hospitalized with a diagnosis diabetic ketoacidosis (DKA). Acute kidney injury is one of the most common causes of renal injury that can arise from several aetiologies. Based on predisposing factors, the causes may be categorized into 3 classes: pre-renal, renal or post-renal. In cases of volume depletion, like that which occurs in diabetic ketoacidosis (a complication of diabetes where there is high ketone production), perfusion to kidneys is impaired and that is when the kidneys start to lose their functioning. Since acute kidney injury in children is associated with a poor short term and long term outcome, in a new JAMA article, and for the first time, researchers have evaluated the rate of acute kidney injury (AKI) in pediatric patients who were hospitalized for the diabetic ketoacidosis. This study was conducted at the British Columbia Childrens Hospital from 2008 through 2013. 165 children aged 18 years or younger with type 1 diabetes, DKA and with complete medical records available for data analysis were included. The primary outcome was the development of acute kidney injury defined using Kidney Disease/Improving Global Outcomes serum creatinine criteria. As per findings, in the designed timeframe, of the 165 children hospitalized for DKA, 106 (64.2%) developed AKI.Two children required hemodialysis. Statistical analysis has shown that a serum bicarbonate level of less than 10 mEq/L was associated with a 5-fold increased risk of developing severe kidney injury. This means that the incidence of acute kidney injury is directly associated with the severity of the a Continue reading >>

Children With Diabetic Ketoacidosis At High Risk Of Aki

Children With Diabetic Ketoacidosis At High Risk Of Aki

A 22% increase in odds of developing AKI was seen for each initial heart rate increase of 5 beats per minute. Among children with type 1 diabetes, new data published in JAMA Pediatrics demonstrate that a high proportion of those who are hospitalized for diabetic ketoacidosis (DKA) develop acute kidney injury (AKI). The researchers of the study aimed to establish the proportion of children hospitalized for DKA who develop AKI, and to ascertain the clinical and biochemical markers associated with AKI. Overall, the medial record review included all DKA admissions from September 1, 2008, through December 31, 2013, that were conducted at the British Columbia Childrens Hospital in British Columbia, Canada. The researchers included 165 children (age, 18 years; median age, 10.6 years; 53.9% female) with type 1 diabetes and DKA and with complete medical records available for analysis. The primary outcome was AKI, defined via the Kidney Disease/Improving Global Outcomes serum creatinine criteria. The researchers used multinomial logistic regression to determine potential factors associated with AKI. Results indicated that 64.2% of children developed AKI , of whom 34.9% had stage 1, 45.3% had stage 2, and 19.8% had stage 3, and 2 children required hemodialysis . According to the adjusted multinomial logistic regression model, a serum bicarbonate level <10 mEq/L compared with 10 mEq/L yielded a more than 5-fold increase in the likelihood of severe (stage 2 or 3) AKI (adjusted odds ratio [aOR], 5.22; 95% CI, 1.35-20.22). For each initial heart rate increase of 5 beats per minute, the researchers observed a 22% increase in the odds for severe AKI (aOR, 1.22; 95% CI, 1.07-1.39). In addition, compared with an initial corrected sodium level of 135-144 mEq/L, those with a level of 145 m Continue reading >>

(pdf) Acute Kidney Injury Among Adult Patients With Diabetic Ketoacidosis In A Referral Hospital Of Bangladesh

(pdf) Acute Kidney Injury Among Adult Patients With Diabetic Ketoacidosis In A Referral Hospital Of Bangladesh

Acute Kidney Injury among Adult Patients with Diabetic Ketoacidosis in a Referral Hospital of Bangladesh Rahim MAa*, Ananna MAa*, Zaman Sb, Rouf Rc, Ahmed AUd, Hossain RMe, Chowdhury TAf, Saha SKf, Samad Ta, Mitra Pg, Iqbal Sh, Uddin KNi, Latif ZAj Background: Diabetic ketoacidosis (DKA) is a medical emergency. DKA may be complicated by acute kidney injury (AKI) and may require renal replacement therapy. Early detection and treatment including treatment of underlying cause and complication(s), if present, is important in determining outcome of DKA. This study was designed to evaluate the incidence of AKI among patients with DKA. Methods: This cross-sectional study was done in BIRDEM General Hospital, Dhaka, Bangladesh from 2008 to 2011. AKI was diagnosed by using acute kidney injury network (AKIN) criteria. Results: Total patients were 200 with slight female predominance (56%). Mean age of the study subjects was 37.67.5 years. Incidence of DKA was more in known diabetic patients (71%), more among rural population (53%) and low income group (76.5%). Infection (40.5%) was the commonest precipitating cause followed by non-adherence to insulin therapy (31%). Acute pancreatitis (5%), myocardial infarction (2%), stroke (1%) and surgery (1.5%) were less common causes and aetiology could not be identified in 14% cases. Fifty nine (29.5%) cases were complicated by AKI and among them three (5%) patients required haemodialysis. AKI was more in severe DKA (pH <7) cases and when precipitated by acute pancreatitis and infections. In spite of standard Conclusion: Almost one-third of DKA cases had AKI in this study, more in DKA cases precipitated by acute pancreatitis and sepsis. Fluid resuscitation resolved AKI in most cases but few cases required renal replacement Key words: acute k Continue reading >>

Acute Kidney Injury As A Severe Complication Of Diabetic Ketoacidosis

Acute Kidney Injury As A Severe Complication Of Diabetic Ketoacidosis

Endocrine Abstracts (2015) 39 EP55 | DOI: 10.1530/endoabs.39.EP55 Acute kidney injury as a severe complication of diabetic ketoacidosis Alagusutha Jeyaraman1, Verghese Mathew1, Eric Finlay2 & Sanjay Gupta1 Author affiliations View ePoster Download ePoster 1Hull Royal Infirmary, Hull, UK; 2General Infirmary, Leeds, UK. Background: Diabetic ketoacidosis (DKA) in children and young adults carries significant morbidity and mortality relating to complications such as cerebral oedema. Acute kidney injury (AKI) is a rare but potentially fatal complication of DKA. We present three cases of DKA complicated by AKI. Case 1: A 9-year-old girl presented with severe DKA at diagnosis. She was treated with intravenous fluids and insulin as per protocol. She had oliguria and haematuria 36 h after admission. She was hypertensive with evidence of enlarged kidneys on ultrasound (USS). She was transferred to the renal unit where she needed two cycles of hemodialysis before making full recovery. Case 2: A 14-year-old girl presented with severe DKA and altered consciousness at diagnosis. She developed oliguria 24 h after starting treatment for DKA. USS of abdomen showed enlarged kidneys. Her renal function improved with haemofiltration and recovered fully by 1 week. Case 3: 17-year-old girl with poorly controlled type 1 diabetes presented with severe DKA. She showed evidence of AKI with very high plasma creatinine, oliguria and low plasma phosphate. She was managed conservatively with individualised fluid plan and phosphate supplementation with recovery in 7 days. Conclusion: Patients with severe DKA can develop AKI due to a number of possible causes, hypovolaemia being the most likely primary cause. Appropriate management of hypovolemia and electrolyte disturbance in these patients can be v Continue reading >>

Diabetic Ketoacidosis Associated With Acute Kidney Injury

Diabetic Ketoacidosis Associated With Acute Kidney Injury

A new Journal of American Medical Association article has shown that there is a high rate of occurrence of acute kidney injury (AKI) in children hospitalized with a diagnosis diabetic ketoacidosis (DKA). Acute kidney injury is one of the most common causes of renal injury that can arise from several aetiologies. Based on predisposing factors, the causes may be categorized into 3 classes: pre-renal, renal or post-renal. In cases of volume depletion, like that which occurs in diabetic ketoacidosis (a complication of diabetes where there is high ketone production), perfusion to kidneys is impaired and that is when the kidneys start to lose their functioning. Since acute kidney injury in children is associated with a poor short term and long term outcome, in a new JAMA article, and for the first time, researchers have evaluated the rate of acute kidney injury (AKI) in pediatric patients who were hospitalized for the diabetic ketoacidosis. This study was conducted at the British Columbia Children’s Hospital from 2008 through 2013. 165 children aged 18 years or younger with type 1 diabetes, DKA and with complete medical records available for data analysis were included. The primary outcome was the development of acute kidney injury defined using Kidney Disease/Improving Global Outcomes serum creatinine criteria. As per findings, in the designed timeframe, of the 165 children hospitalized for DKA, 106 (64.2%) developed AKI.Two children required hemodialysis. Statistical analysis has shown that a serum bicarbonate level of less than 10 mEq/L was associated with a 5-fold increased risk of developing severe kidney injury. This means that the incidence of acute kidney injury is directly associated with the severity of the acidosis resulting from DKA. Increase in heart rate (demo Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Author: Osama Hamdy, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria. The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The following are other signs and symptoms of DKA: Malaise, generalized weakness, and fatigability Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia Rapid weight loss in patients newly diagnosed with type 1 diabetes History of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons or history of mechanical failure of insulin infusion pump Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but may occur when the condition is neglected or with severe dehydration/acidosis Signs and symptoms of DKA associated with possible intercurrent infection are as follows: Glaser NS, Marcin JP, Wootton-Gorges SL, et al. Correlation of clinical and biochemical findings with diabetic ketoacidosis-related cerebral edema in children using magnetic resonance diffusion-weighted imaging. J Pediatr. 2008 Jun 25. [Medline] . Umpierrez GE, Jones S, Smiley D, et al. Insulin analogs versus human insulin in the treatment of patients with diabetic ketoacidosis: a randomized controlled trial. Diabetes Care. 2009 Jul. 32(7):1164-9. [Medline] . [Full Text] . Herrington WG, Nye HJ, Hammersley MS, Watkinson PJ. Are arterial and venous samples clinically equivalent for the estimation Continue reading >>

Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

Go to: Introduction The incidence of diabetes mellitus is increasing worldwide affecting both types of the disease. The most frequent acute diabetic complications are hyperglycemic crises, namely diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state. Diabetic ketoacidosis results from an absolute insulin deficiency. Classical presentation associates a triad of uncontrolled hyperglycemia, metabolic acidosis and high ketone bodies concentration. Similarly to diabetes, the incidence of DKA increases over time [1], [2]. This may be a life-threatening condition due to severe clinical and biological impairments and treatment associated complications (cerebral edema, acute respiratory distress syndrome, hypokalaemia, hypophosphatemia). However, mortality is low and most of the time, death is related to the precipitating factor [3]–[6]. For this reason, admission of these patients in ICU is still debated. A grading system for severity of DKA was described previously [7]. Patients presenting the most severe grades or common severity criteria were considered for ICU admission. However this grading system is not recommended for clinical practice, resulting in wide variations in ICU utilisation for DKA, depending on the national practices, the number of DKA admitted in the units and the severity of the clinical status [8]. Interestingly, in the absence of randomised trials, there are no data showing any impact of the level of care on DKA mortality. To help clinicians, guidelines for DKA management are published and updated by the American Diabetic Association [6]. Their effect on clinical outcome is unclear as compliance to guidelines is poor in diabetes care and ICU [9], [10]. However, implementation of a local mandatory protocol seems more efficient to decrease ICU a Continue reading >>

Rhabdomyolysis-induced Acute Kidney Injury In Diabetic Emergency: Underdiagnosed And An Important Association To Be Aware Of

Rhabdomyolysis-induced Acute Kidney Injury In Diabetic Emergency: Underdiagnosed And An Important Association To Be Aware Of

Volume 2018 |Article ID 4132738 | 3 pages | Rhabdomyolysis-Induced Acute Kidney Injury in Diabetic Emergency: Underdiagnosed and an Important Association to Be Aware of ,1 Bhavika Gandhi,1 Steven Torre,1 Alireza Amirpour,1 Jennifer Cheng,2 Mayurkumar Patel,1 and Mohammad A. Hossain1 1Department of Medicine, Internal Medicine Residency Program, Hackensack Meridian Health, Jersey Shore University Medical Center, Neptune, New Jersey 07753, USA 2Endocrine Service, Nephrology Service, Hackensack Meridian Health Cancer Care, Jersey Shore University Medical Center, Neptune, New Jersey 07753, USA Rhabdomyolysis is a potentially life-threatening clinical syndrome associated with muscle injury which can cause a leakage of intracellular contents, manifested from the range of being asymptomatic to a life-threatening condition causing acute kidney injury and severe electrolyte abnormalities. Rhabdomyolysis has been associated with both diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome, though there is an increased association with rhabdomyolysis and acute kidney injury with hyperosmolar nonketonic state compared with patients with diabetic ketoacidosis. Common clinical manifestations are muscle pain, dark urine, and generalized weakness. The causes of rhabdomyolysis are broadly categorized into three groups: traumatic, nontraumatic exertional, and nontraumatic nonexertional. Here, we present a case of rhabdomyolysis-induced acute kidney injury in a patient with hyperosmolar hyperglycemic state. The patient was discharged on insulin and needed intermittent dialysis for two months. Our case highlights the importance of the rare association of rhabdomyolysis causing acute kidney injury in a diabetic emergency. Rhabdomyolysis is a syndrome caused by muscle Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Pre-diabetes (Impaired Glucose Tolerance) article more useful, or one of our other health articles. See also the separate Childhood Ketoacidosis article. Diabetic ketoacidosis (DKA) is a medical emergency with a significant morbidity and mortality. It should be diagnosed promptly and managed intensively. DKA is characterised by hyperglycaemia, acidosis and ketonaemia:[1] Ketonaemia (3 mmol/L and over), or significant ketonuria (more than 2+ on standard urine sticks). Blood glucose over 11 mmol/L or known diabetes mellitus (the degree of hyperglycaemia is not a reliable indicator of DKA and the blood glucose may rarely be normal or only slightly elevated in DKA). Bicarbonate below 15 mmol/L and/or venous pH less than 7.3. However, hyperglycaemia may not always be present and low blood ketone levels (<3 mmol/L) do not always exclude DKA.[2] Epidemiology DKA is normally seen in people with type 1 diabetes. Data from the UK National Diabetes Audit show a crude one-year incidence of 3.6% among people with type 1 diabetes. In the UK nearly 4% of people with type 1 diabetes experience DKA each year. About 6% of cases of DKA occur in adults newly presenting with type 1 diabetes. About 8% of episodes occur in hospital patients who did not primarily present with DKA.[2] However, DKA may also occur in people with type 2 diabetes, although people with type 2 diabetes are much more likely to have a hyperosmolar hyperglycaemic state. Ketosis-prone type 2 diabetes tends to be more common in older, overweight, non-white people with type 2 diabetes, and DKA may be their Continue reading >>

Diabetic Ketoacidosis Increases Risk Of Acute Renal Failure In Pediatric Patients With Type 1 Diabetes

Diabetic Ketoacidosis Increases Risk Of Acute Renal Failure In Pediatric Patients With Type 1 Diabetes

Condition often under-recognized, yet preventable and treatable. Diabetic ketoacidosis (DKA) is a syndrome presenting in people with diabetes when insulin utilization is markedly diminished, whether via sudden increases in insulin requirements (most often due to acute illness) or sharp decreases in exogenous insulin administration (sudden cessation, for example). DKA is manifested as severe hyperglycemia, systemic acidosis, and severe dehydration due to rapidly increasing osmotic diuresis. This condition is especially worrisome in the pediatric diabetic population, as the resulting risk of renal injury often goes unrecognized at presentation. In 2014, the results of the SEARCH for Diabetes in Youth Study suggested that approximately 30% of pediatric (<18 y.o.) type 1 diabetes patients presented with DKA at initial diagnosis. Other studies have looked at the treatment of DKA in the pediatric population, and its effects on morbidity and mortality, but until now, none have attempted to correlate DKA and acute renal failure. The current issue of JAMA Pediatric presents a study looking at the incidence of acute kidney injury in pediatric patients hospitalized for DKA and attempts to show a correlation between the two events. This retrospective review collected data on pediatric T1D patients admitted to the British Columbia Children’s Hospital with DKA between September 2008 and December 2013. Patients with the above mentioned conditions and complete medical records during that period were included. The primary objective was to determine the proportion of eligible subjects who developed acute kidney injury (AKI). During the prescribed time frame, 211 children were hospitalized at BCCH with DKA. Of these, 165 admissions met criteria for the study. Demographically, 53.9% were Continue reading >>

Acute Kidney Injury: A Guide To Diagnosis And Management

Acute Kidney Injury: A Guide To Diagnosis And Management

Acute kidney injury is characterized by abrupt deterioration in kidney function, manifested by an increase in serum creatinine level with or without reduced urine output. The spectrum of injury ranges from mild to advanced, sometimes requiring renal replacement therapy. The diagnostic evaluation can be used to classify acute kidney injury as prerenal, intrinsic renal, or postrenal. The initial workup includes a patient history to identify the use of nephrotoxic medications or systemic illnesses that might cause poor renal perfusion or directly impair renal function. Physical examination should assess intravascular volume status and identify skin rashes indicative of systemic illness. The initial laboratory evaluation should include measurement of serum creatinine level, complete blood count, urinalysis, and fractional excretion of sodium. Ultrasonography of the kidneys should be performed in most patients, particularly in older men, to rule out obstruction. Management of acute kidney injury involves fluid resuscitation, avoidance of nephrotoxic medications and contrast media exposure, and correction of electrolyte imbalances. Renal replacement therapy (dialysis) is indicated for refractory hyperkalemia; volume overload; intractable acidosis; uremic encephalopathy, pericarditis, or pleuritis; and removal of certain toxins. Recognition of risk factors (e.g., older age, sepsis, hypovolemia/shock, cardiac surgery, infusion of contrast agents, diabetes mellitus, preexisting chronic kidney disease, cardiac failure, liver failure) is important. Team-based approaches for prevention, early diagnosis, and aggressive management are critical for improving outcomes. The incidence of acute kidney injury has increased in recent years, both in the community and in hospital settings.1,2 Continue reading >>

Severe Acute Renal Failure In A Patient With Diabetic Ketoacidosis

Severe Acute Renal Failure In A Patient With Diabetic Ketoacidosis

1 King Khalid National Guard Hospital, Jeddah, Kingdom of Saudi Arabia, Department of Pediatrics, Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Canada, Canada 2 Department of Pediatrics, Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Canada Click here for correspondence address and email Acute renal failure (ARF) is a rare but potentially fatal complication of diabetic ketoacidosis (DKA). Early recognition and aggressive treatment of ARF during DKA may improve the prognosis of these patients. We present a case report of a 12 year old female admitted to the hospital with severe DKA as the 1s t manifestation of her diabetes mellitus. She presented with severe metabolic acidosis, hypophosphatemia, and oliguric ARF. In addition, rhabdomyolysis was noted during the course of DKA which probably contributed to the ARF. Management of DKA and renal replacement therapy resulted in quick recovery of renal function. We suggest that early initiation of renal replacement therapy for patients with DKA developing ARF may improve the potentially poor outcome of patients with ARF associated with DKA. How to cite this article: Al-Matrafi J, Vethamuthu J, Feber J. Severe acute renal failure in a patient with diabetic ketoacidosis. Saudi J Kidney Dis Transpl 2009;20:831-4 Diabetic ketoacidosis (DKA) occurs in 10 to 70% of children with type 1 diabetes mellitus (DM1) and has a significant risk of mortality, mostly due to cerebral edema. [1] Other potential complications of DKA include hypokalemia, hypophosphatemia, hypoglycemia, intracerebral and peripheral venous thrombosis, mucormycosis, rhabdomyolysis, acute pancreatitis, acute renal failure (ARF) and sepsis. The development of ARF with rhabdomyolysis is a rare but potentially lethal diso Continue reading >>

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