Acute hypoxic hepatitis as a complication of diabetic ketoacidosis in a boy with newly diagnosed diabetes

Introduction
Hypoxic hepatitis is characterised by centrilobular liver cell necrosis associated with a rapid and transient increase in serum aminotransferase levels (ALT, AST) in critically ill patients. The aim of this paper is to present a case report of a paediatric patient with severe ketoacidosis in the course of newly diagnosed diabetes types 1 complicated by hypoxic hepatitis.

Case report
A boy, nearly three years old, was admitted to the hospital with ketoacidosis (pH – 7.058, BE – 28.3 mmol/l, HCO3 – 6.3 mmol/l) and glucose level of 434 mg/dl (24.1 mmol/l). After 48 hours of treatment with fluids and insulin infusion the serum glucose level and acidosis normalised. On the fourth day of hospitalisation, laboratory tests revealed a rapid increase in AST (to 12955 IU/l) and ALT (to 4328 IU/l) concentrations. Increased GGTP level (346 IU/l) and mild coagulation disorders (INR = 0.78) were also observed. In the following days a gradual decrease in transaminase and normalisation of the coagulation system were observed.

Conclusions
Severe diabetic ketoacidosis with significant dehydration and hypovolaemic shock may lead to hypoxic hepatitis, also in small children.