Severe diabetic ketoacidosis with multiple rare complications: A case report

Severe diabetic ketoacidosis (DKA) in children may present with uncommon, high-risk complications needing rapid recognition and multidisciplinary care. We report an 8-year-old boy with DKA complicated by spontaneous pneumothorax, acute popliteal arterial thrombosis with limb ischemia, superficial venous thrombosis, rhabdomyolysis, and severe gastroparesis. Management included insulin infusion with protocolized fluids/electrolytes, intercostal drainage, thrombectomy with fasciotomy, anticoagulation, hyperhydration, and prokinetic therapy. Evaluation for prothrombotic predisposition revealed homozygous MTHFR C677T mutation. The child recovered fully with limb salvage. This case underscores the need for awareness of and vigilance regarding rare complications in pediatric DKA and emphasizes the need for prompt, coordinated, organ-specific interventions.