Hypoxic hepatitis is characterized by centrilobular liver cell necrosis along with a rapid and transient elevation in serum aminotransferase levels (ALT, AST) in critically ill patients. The current study includes a case report of a paediatric patient with severe ketoacidosis in the course of newly diagnosed diabetes types 1 complicated by hypoxic hepatitis.

A 3 year old boy was admitted to the hospital with ketoacidosis (pH - 7.058, BE - 28.3 mmol/l, HCO3 - 6.3 mmol/l) and glucose level of 434 mg/dl (24.1 mmol/l). He was administered with fluids and insulin infusion. Post 48 hours of treatment, he achieved normal serum glucose level and acidosis. However, laboratory tests on the fourth day of hospitalisation showed rapid increase in AST (to 12955 IU/l) and ALT (to 4328 IU/l) concentrations. Additionally, increased gamma glutamyltranspeptidase (GGTP) level (346 IU/l) and mild coagulation disorders (INR = 0.78) were also reported. Nevertheless, In the following days a slow decrease in transaminase was seen in the subsequent days and coagulation system got normalized.

Therefore, the study concluded that pediatric patients with severe diabetic ketoacidosis along with significant dehydration and hypovolaemic shock may cause hypoxic hepatitis.

Source: Pediatr Endocrinol Diabetes Metab. 2020;26(2):108-112.