A novel indication of Extra-Corporeal Life Support (ECLS) in a Child with Diabetes-related Hyperglycemic Emergency
CCCF ePoster library. Yang G. Oct 26, 2015; 117373; P1
Dr. Gaby Yang
Dr. Gaby Yang
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Topic: Case Report

A novel indication of Extra-Corporeal Life Support (ECLS) in a Child with Diabetes-related Hyperglycemic Emergency

Gaby Yang, M. Bennett, B. Hursh

Pediatric Critical Care Medicine, University of British Columbia, Vancouver, Canada | Pediatric Critical Care Medicine, University of British Columbia, Vancouver, Canada | Pediatric Endocrinology, University of British Columbia, Vancouver, Canada


Hyperglycemic diabetic emergencies can be life-threatening conditions that are survivable if identified and treated appropriately. Cardiac arrests are rare and unexpected sequelae. The etiology for cardiovascular failure is multi-factorial, with dehydration and electrolyte derangements as important contributors. We present a case of a teen with diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS) who developed circulatory failure, which was successfully managed with extracorporeal membrane oxygenation (ECMO).

Objectives: NA

Methods: NA

Results: Our patient is a 15 years old First Nations boy who presented in severe DKA. He received 45ml/kg of normal saline bolus, followed by 120% maintenance and insulin at 0.1 units/kg/hr. He was initially neurologically appropriate, but subsequently deteriorated necessitating intubation. He became febrile with episodic supraventricular tachycardia up to 200 beats per minute, followed by progressive hypotension requiring epinephrine and norepinephrine. Echocardiogram showed high-output cardiac failure. Concurrently, he developed marked hypokalemia (1.8mmol/L) and hypophosphatemia (0.26mmol/L), and became more acidotic. He was cannulated to veno-arterial ECMO for impending circulatory collapse. He remained on ECMO support for 30 hours, during which her received massive volume and electrolyte replacements. Hemodynamics improved over 24 hours. DKA resolved over 3 days; he was transitioned to subcutaneous insulin 8 days after presentation.

Conclusion: To our knowledge this is a novel use of ECMO to prevent circulatory collapse in a pediatric patient with diabetes. Circulatory collapse is a rare complication of hyperglycemic diabetic emergencies, but should be suspected early in patients with profound electrolyte derangements and dehydration. Early cannulation to ECMO in cases of impending cardiac failure maybe life-saving and serve as bridging therapy to correct metabolic derangements.

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