New‐onset type 1 diabetes complicated by diabetic ketoacidosis and severe sepsis requiring extracorporeal membrane oxygenation and kidney replacement therapy


Diabetic ketoacidosis (DKA) accounts for up to a third of all new presentations of Type 1 Diabetes Mellitus (T1DM) in children and adolescents. While most cases are relatively uncomplicated new onset presentations, if DKA is compounded with an additional underlying severe illness, such as appendicitis or severe infection, diagnostic delays may be experienced, and treatment response and outcomes may be compromised. We report an atypical case of new onset diabetes with severe DKA and underlying severe sepsis, which responded poorly to traditional therapy resulting in maximal intensive care management including mechanical ventilation, inotropes, extracorporeal membrane oxygenation (ECMO) for cardiorespiratory support, and kidney replacement therapy.

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Corresponding author

Correspondence to Benjamin J. Wheeler.

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The authors declare that there are no conflicts of interest in preparing this case report. 

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Learning points

1) DKA is common in childhood type 1 diabetes and occurs in approximately 30 % of new onset cases.

2) If presentation or response to treatment is atypical, consideration for co-morbid infection, metabolic, endocrine, or other medical/surgical conditions should be given.

3) Advanced intensive care modalities such as extracorporeal membrane oxygenation (ECMO) are a potential option for immediately life threatening and not resolving acute cardio-respiratory comorbidities or complications of type 1 diabetes.

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Asarani, N.A.M., Paddison, J., Walker, R. et al. New‐onset type 1 diabetes complicated by diabetic ketoacidosis and severe sepsis requiring extracorporeal membrane oxygenation and kidney replacement therapy. J Diabetes Metab Disord (2021).

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  • Type 1 diabetes
  • Extracorporeal membrane oxygenation
  • Ketoacidosis diabetic
  • Kidney replacement therapy
  • Acute renal injury
  • Severe sepsis