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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P1


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

Introduction:

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.

References:
  1. Dabelea D, Rewers A, Stafford JM, et al. Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for diabetes in youth study. Pediatrics 2014; 133: e938-e945
  2. American Diabetes Association. Consensus statement: type 2 diabetes in children. Diabetes Care 2000; 23: 381-9.
  3. de Vaan GAM. Hyperosmolar diabetisch coma zonder ketoacidose. Maandschr Kindergeneeskd 1966; 34: 279-83.
  4. Rosenbloom AL. Hyperglycemic hyperosmolar state: an emerging pediatric problem. J Pediatr 2010; 156: 180-4.
  5. Edge JA, Ford-Adams ME, and Dunger DB. Cause of death in children with insulin depdent diabetes 1990-96. Arch Dis Child 1999; 81: 318-323.
  6. Bialo SR, Agrawal S, Boney CM, et al. Rare complications of pediatric diabetic ketoacidosis. World J Diabetes 2015; 6(1): 167-174.
  7. Zietler P, Haqq A, Rosenbloom A et al. Hyperglycemic Hyperosmolar Syndrome in Children: Pathophysiological Considerations and Suggested Guidelines for Treatment. J Pediatr 2011; 158 (1): 9-14.
  8. Himufi T, Kiriu N, Kato H, et al. Survival after prolonged resuscitation from cardiac arrest due to diabetic ketoacidosis using extracorporeal life support. Am J Emerg Med 2013; 31: 891e1-892e2.
  9. Chen HT, Ong JR, Hung SW, et al. Survival after prolonged resuscitation from cardiac arrest in a case of severe diabetic ketoacidosis. Am J Emerg Med 2006; 24(5): 633-634.
  10. Kamarzaman Z, Turner C, and Clark F. How low can you go: a case presentation on a patient with diabetic ketoacidosis. Resuscitation 2009 Aug; 80(8): 967-8.
  11. Grimberg A, Cerri RW, Satin-Smith M, et al. The “two-bag” system for variable intravenous dextrose and fluid administration: Benefits in diabetic ketoacidosis management. J Pediatr 1999; 134: 376-378.
  12. Morales AE and Rosenbloom AL. Death Caused by Hyperglycemic Hyperosmolar State at the onset of Type 2 Diabetes. J Pediatr 2004; 144: 270-3.
  13. Ditzel J and Lervang H. Disturbance of inorganic phosphate metabolism in diabetes mellitus: clinical manifestations of phosphorus-depletion syndrome during recovery from diabetic ketoacidosis. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2010:3 319-324.
  14. Riley MS, Shade DS, and Eaton RP. Effects of insulin injection on plasma phosphate in diabetic patients. Metabolism 1979; 28(3): 191–194.
  15. Davis SV et al. Reversible depression of myocardial performance in hypophosphatemia. Am J Med Sci 1988; 295: 183–187.
  16. Cochran JB, Walters S and Losek JD. Pediatric hyperglycemic hyperosmolar syndrome: diagnostic difficulties and high mortality rate. Am J Emerg Med 2006: 24; 297-301.
  17. Hollander AS, Olney RC, Blackett PR and Marshall BA. Fatal Malignant Hyperthermia-Like Syndrome With Rhabdomyolysis Complicating the Presentation of Diabetes Mellitus in Adolescent Males. Pediatrics 2003; 111: 1447-51.
  18. Kilbane BJ, Mehta S, Backeljauw PF et al. Approach to management of malignant hyperthermia-like syndrome in pediatric diabetes mellitus. Pediatr Crit Care Med 2006: 7; 169-173.
  19. Murthy S and Sharara-Chami R. Aggressive fluid resuscitation in severe pediatric hyperglycemic hyperosmolar syndrome: a case report. Int J Pediatr Endocrinol 2010: 1-4.
  20. Segura LG, Lorenz JD, Weingarten TN, et al. Anesthesia and Duchenne or Becker muscular dystrophy: review of 117 anesthetic exposures. Paediatr Anaesth 2013 Sep; 23(9): 855-64.
  21. Dunger DB, Sperling MA, Acerini CL, et al. European Society for Pediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society consensus statement on diabetic ketoacidosis in children and adolescents. Pediatrics 2004; 113: e133-e140.
  22. Wolfsdorf J, Glaser N, and Sperling MA. Diabetic ketoacidosis in infants, children, and adolescents. A consensus statement from the American Diabetes Association. Diabetes Care 2006; 29: 1150-1159.
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