Hypoxic hepatitis as a complication of newly diagnosed type 1 diabetes in a teenager

Abstract

Hypoxic hepatitis is a rare complication of type 1 diabetes with unknown prevalence in Pediatrics. We present a case report of an 11-year-old boy admitted to the ER in the spring of 2020 (the beginning of the COVID19 pandemic in Poland) due to nausea, abdominal pain, and weight loss. A diagnosis of type 1 diabetes accompanied by severe ketoacidosis (pH 6.9, blood glucose 632mg/dl, ketone bodies in urine -150mg/dl) was made. The hyperglycemia, ketoacidosis, and waterelectrolyte disturbances were treated in the Pediatric Intensive Care Unit. On day 4, the boy developed fulminant septic shock with high aminotransferases (AST 9026 U/l, ALT 3559 U/l). CT scan revealed hepatic enlargement and steatosis. Acute viral hepatitis was suspected. The levels of anti-CMV IgM and IgG antibodies were slightly elevated. At autopsy, the liver was enlarged, with petechial bleedings on the surface. The liver parenchyma was congested, with signs of steatosis. Microscopically, there was extensive centrilobular necrosis, acute passive sinusoidal congestion, and steatosis of hepatocytes. There were no signs of CMV infection. Based on the entire clinicopathological picture, the patient was diagnosed with hypoxic hepatitis, complicated by septic shock and multiple organ failure.

Severe multiple organ failure as a consequence of diabetic ketoacidosis in an adolescent with new-onset type 1 diabetes: A case report

“…A recent case report describes an 11-year-old patient who presented with new-onset T1D and, after 4 days of treatment for DKA, developed significant hepatic failure and hepatomegaly and ultimately died despite aggressive therapies. 17 Autopsy findings were consistent with hypoxic hepatitis, which is described as the combination of "passive congestion, poor oxygen utilization, and reperfusion injury." 17 A possible contributor of the acute hepatic failure could be the challenges in maintaining euvolemia early in the hospital course.…”

“…17 Autopsy findings were consistent with hypoxic hepatitis, which is described as the combination of "passive congestion, poor oxygen utilization, and reperfusion injury." 17 A possible contributor of the acute hepatic failure could be the challenges in maintaining euvolemia early in the hospital course. Treatment is focused on supporting the underlying disease process, such as DKA, and maintaining appropriate vital parameters to ensure adequate tissue perfusion to the vital organs.…”

“…Treatment is focused on supporting the underlying disease process, such as DKA, and maintaining appropriate vital parameters to ensure adequate tissue perfusion to the vital organs. 17 The incidence of hypoxic hepatitis is unknown in the pediatric population but should be considered in patients with DKA who are demonstrating worsening liver function.…”

Comparative Hepatoprotective Activity of Vernonia amygdalina Leaf Solvent Extracts in Alloxan-Induced Diabetic Rats

“…It affects lipid, carbohydrate, and protein metabolism; resulting in non-alcoholic steatohepatitis, cirrhosis, and hepatocellular carcinomas. 37,38 The diabetogenic property of alloxan is mediated by oxidative stress which causes β-islets cell necrosis and dysfunction. The increase in oxidative stress and abnormal inflammatory response activate pro-apoptotic genes; harm hepatocytes, resulting in diabetes-induced liver damage.…”