title: Deep vein thrombosis and pulmonary embolism in a child with diabetic ketoacidosis and protein s deficiency: a case report.
abstract: BACKGROUND
  Diabetic ketoacidosis (DKA) is considered a hypercoagulable state, which may be exacerbated in patients with thrombophilia and lead to thrombosis.
  
  
  METHODS
  We report on a 5.5-year-old boy, who was admitted to the pediatric department with DKA due to newly diagnosed type 1 diabetes. Low-grade fever was reported for 6 days prior to admission and continued during DKA management, with negative septic screening. After DKA management, the child developed symptoms of iliofemoral deep vein thrombosis (DVT). A family history of protein S (PS) deficiency was revealed. He was initially treated intravenously with antibiotics and unfractionated heparin, which, after 2 days, was switched to low-molecular-weight heparin and vitamin K antagonist (VKA) due to poor anticoagulant response. On the 6th day of anticoagulant treatment, the patient presented with pulmonary embolism (PE); he continued with VKA and antibiotics, with significant clinical improvement. Prolonged fever was attributed to DVT and PE. The patient was discharged on oral anticoagulants and insulin.
  
  
  CONCLUSIONS
  We report on a child with congenital PS deficiency and DKA who developed DVT and PE despite anticoagulant treatment. It is important in children presenting with DKA to seek thoroughly for a medical history of thrombophilia and to start early thromboprophylaxis in such cases in order to prevent a possible thrombosis.
authors.affiliation: 2nd Department of Pediatrics, 'P&A Kyriakou' Children's Hospital, Athens University, Athens, Greece.
authors.forename: Triantafyllia
authors.initials: T
authors.lastname: Sdogou
authors.forename: Lydia
authors.initials: L
authors.lastname: Kossiva
authors.forename: Kostas
authors.initials: K
authors.lastname: Kakleas
authors.forename: Helen
authors.initials: H
authors.lastname: Platokouki
authors.forename: Theodora
authors.initials: T
authors.lastname: Tentolouri
authors.forename: Helen
authors.initials: H
authors.lastname: Georgouli
authors.forename: Christina
authors.initials: C
authors.lastname: Karayianni
authors.forename: Kyriaki
authors.initials: K
authors.lastname: Karavanaki
mesh_terms: D002648:Child; D016883:Diabetic Ketoacidosis / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D018455:Protein S Deficiency / Q000150:complications* / Q000188:drug therapy; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000209:etiology*; D020246:Venous Thrombosis / Q000188:drug therapy / Q000209:etiology*