New-onset diabetes mellitus presenting with diabetic ketoacidosis after pediatric liver transplantation.
The development of NODM is a common metabolic complication after liver transplantation. Presentation of post-liver transplant diabetes mellitus with DKA is rare especially among pediatric patients. We reported three pediatric patients who presented with DKA after liver transplantation. The underlying diseases leading to transplantation were cryptogenic liver cirrhosis, Wilson disease, and congenital hepatic fibrosis. None of the three patients had a history of diabetes prior to transplantation and all of them were cases of NODM after transplantation. All three patients presented with severe hyperglycemia, significant ketosis, and metabolic acidosis of variable severity. All of them received tacrolimus as one of the immunosuppressant agents. The patients received a liver transplant from a DD. The patients were treated with intravenous insulin injection (0.1 U/kg/h) and recovered from DKA, but one case expired in the intensive care unit because of bacterial sepsis after recovery from DKA. Our experience suggests that PTDM may result in ketoacidosis, and we emphasize the importance of paying more attention to glucose metabolism and risk of diabetes mellitus in patients with immunosuppressive therapy, especially tacrolimus.
Dehghani
Seyed Mohsen
SM
Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. dehghanism@sums.ac.ir
Nikeghbalian
Saman
S
Eshraghian
Ahad
A
Haghighat
Mahmood
M
Imanieh
Mohammad Hadi
MH
Bahador
Ali
A
Kazemi
Kourosh
K
Malek-Hosseini
Seyed Ali
SA
D000293:Adolescent; D002648:Child; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000209:etiology; D016883:Diabetic Ketoacidosis / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007662:Ketosis; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D011183:Postoperative Complications; D016559:Tacrolimus / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D007328:Insulin; D016559:Tacrolimus