Severe Rhabdomyolysis and Acute Renal Failure Treated by Continuous Venovenous Hemodiafiltration in a Child with Diabetic Ketoacidosis
Ayhan Yaman
Keywords :
Acute renal failure, Continuous venovenous hemodiafiltration, Critically ill, Diabetic ketoacidosis, Hypophosphatemia, Intensive care unit, Mechanical ventilation
Citation Information :
Yaman A. Severe Rhabdomyolysis and Acute Renal Failure Treated by Continuous Venovenous Hemodiafiltration in a Child with Diabetic Ketoacidosis. Indian J Crit Care Med 2022; 26 (1):136-138.
Diabetic ketoacidosis (DKA) is the most serious hyperglycemic emergency in patients with type I diabetes mellitus and is associated with significant morbidity and mortality. DKA may be a life-threatening condition due to severe clinical and biological impairments and treatment-associated complications [cerebral edema, acute respiratory failure, acute renal failure (ARF), hypokalemia, hypophosphatemia]. The development of ARF with rhabdomyolysis is a rare but potentially lethal disorder in children with DKA with an estimated mortality of about 50%. Continuous renal replacement therapy is commonly used in intensive care units to provide renal replacement and fluid management. We successfully treated a 13-year-old boy with continuous venovenous hemodiafiltration, who had been diagnosed with severe DKA, complicated with hypophosphatemia-induced acute respiratory failure, rhabdomyolysis and ARF, persistent acidosis, and coma.
Woodrow G, Brownjohn AM, Turney JH. Acute renal failure in patients with type 1 diabetes mellitus. Postgrad Med J 1994;70(821):192–194. DOI: 10.1136/pgmj.70.821.192.
Kitabchi AE, Umpierrez GE, Fisher JN, Murphy MB, Stentz FB. Thirty years of personal experience in hyperglycaemic crises: diabetic ketoacidosis and hyperglycaemic hyperosmolar state. J Clin Endocrinol Metab 2008;93(5):1541–1552.
Lombardo F, Maggini M, Gruden G, Bruno G. Temporal trend in hospitalizations for acute diabetic complications: a nationwide study, Italy, 2001–2010. PLoS One 2013;8(5):63675. DOI: 10.1371/journal.pone.0063675.
Wagner A, Risse A, Brill HL, Wienhausen-Wilke V, Rottmann M, Sondern K, et al. Therapy of severe diabetic ketoacidosis. Zero-mortality under very-low-dose insulin application. Diabetes Care 1999;22(5):674–677. DOI: 10.2337/diacare.22.5.674.
Ezeani I, Eregie A, Ogedengbe O. Treatment outcome and prognostic indices in patients with hyperglycemic emergencies. Diabetes Metab Syndr Obes 2013;6:303–307. DOI: 10.2147/DMSO.S44477.
Efstathiou SP, Tsiakou AG, Tsioulos DI, Zacharos ID, Mitromaras AG, Mastorantonakis SE, et al. A mortality prediction model in diabetic ketoacidosis. Clin Endocrinol 2002;57(5):595–601. DOI: 10.1046/j.1365-2265.2002.01636.x.
Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care 2009;32(7):1335–1343. DOI: 10.2337/dc09-9032.
Rosenbloom AL. The management of diabetic ketoacidosis in children. Diabetes Ther 2010;1(2):103–120. DOI: 10.1007/s13300-010-0008-2.
Al-Matrafi J, Vethamuthu J, Feber J. Severe acute renal failure in a patient with diabetic ketoacidosis. Saudi J Kidney Dis Transpl 2009;20(5):831–834. PMID: 19736483.
Liu PY, Jeng CY. Severe hypophosphatemia in a patient with diabetic ketoacidosis and acute respiratory failure. J Chin Med Assoc 2004;67(7):355–359. PMID: 15510933.
Kawata H, Inui D, Ohto J, Miki T, Suzue A, Fukuta Y, et al. The use of continuous hemodiafiltration in a patient with diabetic ketoacidosis. J Anesth 2006;20(2):129–131. DOI: 10.1007/s00540-005-0385-2.
Yue RZ, Zhang L, Liu F, Fu P. Continuous blood purification therapy on 16 patients with diabetic ketoacidosis and acute kidney injury. Sichuan Da Xue Xue Bao Yi Xue Ban 2012;43(3):434–437. PMID: 22812253.
