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ABSTRACT 256: DIABETIC KETOACIDOSIS (DKA) PRECEDING THROMBOCYTOPENIA ASSOCIATED WITH ACUTE RENAL FAILURE AND PANCREATIC ENZYME ELEVATION.

Merrick, V.1; Malik, M.1; Vaidya, M.1

Pediatric Critical Care Medicine: May 2014 - Volume 15 - Issue 4_suppl - p 61
doi: 10.1097/01.pcc.0000448982.07798.36
Abstracts of the 7th World Congress on Pediatric Critical Care
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1Paediatric Critical Care Medicine, Royal London Hospital, London, United Kingdom

Background and aims: Thrombocytopenia following DKA is a rare complication with several possible aetiologies, each with distinctive approaches to management.

Aims: Case report and discussion.

Methods: A 9-year-old girl presented to the emergency department with a reduced level of consciousness. This was the first presentation of severe DKA in a newly diagnosed diabetic. She was profoundly acidotic (pH 6.83, pCO2 1.99, HCO3 4.7, BE -31.6, glucose 33) and urine was positive for glucose/ketones. Within 12 hours of admission she developed thrombocytopenia (lowest platelet count 31 x 10^6), progressively deteriorating renal function, and a raised amylase.

Written consent was obtained from the patient’s family for publication.

Results: Differential diagnoses of: haemolytic uraemic syndrome, thrombotic thrombocytopenic purpura (TTP), and/or sepsis were considered. Blood film showed no evidence of haemolysis and the ADAMTS 13 (A Disintegrin and Metalloprotease with ThromobSpondin motifs; formerly known as von Willebrand factor cleaving-protease) activity was within the normal range, excluding TTP with associated microangiopathic haemolytic anaemia.

Conclusions: The specific combination of renal failure, thrombocytopenia and pancreatic enzyme elevation is rare following paediatric DKA (in contrast to elevated serum urea, creatinine and amylase; which are relatively common). We have only identified 3 case reports. A key factor is to exclude one of the microangiopathic syndromes (TTP, disseminated intravascular coagulation, thrombotic microangiopathy) associated with low ADAMTS 13 activity and significant mortality. These conditions require urgent plasma exchange to remove ADAMTS 13 inhibitors and dramatically reduce mortality. In our case no such treatment was necessary, and the patient made a full recovery with supportive therapy alone.

©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies