ESPE Abstracts (2019) 92 P3-90

A Management Challenge of Acute Viral Hepatitis A in a Child Presented with DKA as a First Presentation

Dina Fawzy1, asmaa elgebaly2


1alexandria university children's hospital, alexandria, Egypt. 2Ministry of Health, alexandria, Egypt


Background: Diabetic patients frequently develop a constellation of electrolyte disorders. These patients are often potassium-, magnesium- and phosphate-depleted, especially in the context of diabetic ketoacidosis.Patients with type-1 diabetes are predisposed to develop a spectrum of liver diseases, which includes fatty liver, steatohepatitis and cirrhosis. The association of hepatitis A infection with type-1 diabetes is extremely rare.

Case report: a nine year old female child diagnosed with diabetic ketoacidosis as the first presentation of diabetes mellitus (she was complaining of polyuria before presentation and nocturnal enuresis) she was admitted to PICU to receive the appropriate treatment. We noticed that her electrolytes were disturbed; hypomagnesemia, hypocalcemia, hypokalemia and hyponatremia and hypophosphatemia. So urine spots were collected and high urine levels of these electrolytes were found confirming that the girl had a tubular defect. Also serum creatinine were elevated, serum complement 3 sample withdrawn and it was normal. During her stay at the hospital, she developed icterus therefore we investigate to discover the cause of her jaundice. Hepatitis B, C, CMV, EBV, HIV were negative while HAV IgM were positive. Her random blood sugars during the maintenance phase were low despite being on low requirements to her age so, thyroid and celiac profile were withdrawn and pending.

Conclusion: elevated liver enzymes in diabetic patients may be due to causes other than fatty liver and autoimmune hepatitis as infectious hepatitis

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