Pediatric Cirrhotic Variceal Bleed Precipitating Diabetic Ketoacidosis

Area of Science:

• Pediatric Gastroenterology
• Hepatology
• Endocrinology

Background:

• Cirrhosis in children is uncommon, with causes differing from adults, including infection, neoplasm, and metabolic/genetic disorders.
• Variceal bleeding is a serious complication of cirrhosis, associated with significant morbidity and mortality in pediatric patients.
• Acute gastrointestinal bleeding, specifically variceal bleeding, has a complex, multifactorial association with diabetic ketoacidosis.

Observation:

• A pediatric case of cirrhosis with variceal bleeding was complicated by hypovolemic shock.
• Resuscitation and transfusion following hypovolemic shock led to cardiac overload.
• The patient's presentation involved coexisting diabetic ketoacidosis.

Findings:

• The case illustrates a rare instance of variceal bleeding in a child with cirrhosis.
• Diabetic ketoacidosis was identified as a potential contributing factor to the acute gastrointestinal bleeding.
• Inappropriate fluid resuscitation and transfusion management resulted in cardiac overload.

Implications:

• Emphasizes the need for balanced and judicious fluid resuscitation in pediatric patients with gastrointestinal bleeding and shock.
• Highlights the importance of recognizing and managing coexisting conditions, such as diabetic ketoacidosis, in pediatric cirrhosis.
• Underscores the critical role of careful management in preventing secondary complications like cardiac overload during resuscitation.