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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Dabelea D, Rewers A, Stafford JM, Standiford DA, Lawrence JM, Saydah S, et al. Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for diabetes in youth study. Pediatrics. 2014;133(4):e938-e45.
Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32(7):1335–43.
Wolfsdorf J, Craig ME, Daneman D, Dunger D, Edge J, Lee W, et al. Diabetic ketoacidosis in children and adolescents with diabetes. Pediatr Diabetes. 2009;10(s12):118–33.
Cheng Y-C, Huang C-H, Lin W-R, Lu P-L, Chang K, Tsai J-J, et al. Clinical outcomes of septic patients with diabetic ketoacidosis between 2004 and 2013 in a tertiary hospital in Taiwan. J Microbiol Immunol Infect. 2016;49(5):663–71.
Ślusarz K, Kurdyś P, Armatowicz P, Knapik P, Trejnowska E. Extracorporeal membrane oxygenation (ECMO)-in the treatment of severe, life-threatening respiratory failure. Wiad Lek (Warsaw, Poland: 1960). 2019;72(9 cz 2):1822.
Parzy G, Daviet F, Persico N, Rambaud R, Scemama U, Adda M, et al. Prevalence and risk factors for thrombotic complications following venovenous extracorporeal membrane oxygenation: A CT scan study. Crit Care Med. 2020;48(2):192–9.
Rhodes A, Evans L, Alhazzani W, Levy M, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock. Crit Care Med. 2017;45:1.
MacLaren G, Butt W, Best D, Donath S. Central extracorporeal membrane oxygenation for refractory pediatric septic shock. Pediatr Crit Care Med. 2011;12(2):133–6.
American Diabetes Association. 15. Diabetes care in the hospital: Standards of medical care in diabetes—2019. Diabetes Care. 2019;42(Supplement 1):S173-S81.
Rabkin R, Simon NM, Steiner S, Colwell JA. Effect of renal disease on renal uptake and excretion of insulin in man. N Engl J Med. 1970;282(4):182–7.
Naschitz JE, Barak C, Yeshurun D. Reversible diminished insulin requirement during acute renal failure. Postgrad Med J. 1983;59(690):269–71.
Conflicts of interest
The authors declare that there are no conflicts of interest in preparing this case report.
Written informed consent from the patient described has been obtained for publication of the submitted article and accompanying data.
No ethics approval was required for this case report.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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.
About this article
Cite this article
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). https://doi.org/10.1007/s40200-021-00736-z
- Type 1 diabetes
- Extracorporeal membrane oxygenation
- Ketoacidosis diabetic
- Kidney replacement therapy
- Acute renal injury
- Severe sepsis