{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T11:10:38Z","timestamp":1778152238598,"version":"3.51.4"},"reference-count":12,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Following Coronavirus disease 2019 (COVID\u201019) paediatric diabetic ketoacidosis (DKA) incidence and severity rose. We report a 2020\u20132024 cluster of four DKA\u2010associated acute liver failure (ALF) cases at the largest UK paediatric hepatology unit. None had known diabetes. Presentations: one perianal abscess; three reduced consciousness, requiring intubation. Standard UK DKA protocol was started. Admission liver functions were normal. By day 4, all developed cardiovascular instability and ALF with liver injury, coagulopathy, metabolic acidosis, and hyperlactataemia. All required inotropes and haemofiltration. Three arrested; two died. Both autopsies showed centriacinar necrosis, with macro\u2010 and micro\u2010vesicular steatosis. The two survivors normalised liver function. Viral, immune, and metabolic studies were unremarkable. This cluster suggests a novel, severe hepatic phenotype complicating paediatric DKA. Plausible mechanisms include ischaemic hepatitis and drug injury on a background of diabetes\u2010related mitochondrial vulnerability. Earlier recognition of type 1 diabetes and awareness of hepatic complications may reduce morbidity and mortality.<\/jats:p>","DOI":"10.1002\/jpn3.70394","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T09:53:08Z","timestamp":1773136388000},"page":"1278-1283","source":"Crossref","is-referenced-by-count":0,"title":["Paediatric diabetic ketoacidosis\u2010associated acute liver failure in the post\u2010COVID era: A case series"],"prefix":"10.1002","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0907-4718","authenticated-orcid":false,"given":"Vandana","family":"Jain","sequence":"first","affiliation":[{"name":"Paediatric Liver, GI and Nutrition Centre and Mowatlabs Kings College Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anneka","family":"Patel","sequence":"additional","affiliation":[{"name":"Paediatric Liver, GI and Nutrition Centre and Mowatlabs Kings College Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isadora","family":"Feilding","sequence":"additional","affiliation":[{"name":"Paediatric Liver, GI and Nutrition Centre and Mowatlabs Kings College Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma C.","family":"Alexander","sequence":"additional","affiliation":[{"name":"Paediatric Liver, GI and Nutrition Centre and Mowatlabs Kings College Hospital London UK"},{"name":"Paediatric Intensive Care Unit King's College Hospital NHS Foundation Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pam","family":"D'Silva","sequence":"additional","affiliation":[{"name":"Paediatric Intensive Care Unit King's College Hospital NHS Foundation Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"Ponmani","sequence":"additional","affiliation":[{"name":"Paediatric Emergency Medicine Barking Havering and Redbridge University Trust Romford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Chapman","sequence":"additional","affiliation":[{"name":"Paediatric Endocrinology King's College Hospital NHS Foundation Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anil","family":"Dhawan","sequence":"additional","affiliation":[{"name":"Paediatric Liver, GI and Nutrition Centre and Mowatlabs Kings College Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akash","family":"Deep","sequence":"additional","affiliation":[{"name":"Paediatric Intensive Care Unit King's College Hospital NHS Foundation Trust London UK"},{"name":"Department of Women and Children's Health, School of Life Course Sciences King's College London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2018.04.050"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-4642(22)00190-0"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l1114"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/femer.2024.1385450"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.12701"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2005.12.051"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.5114\/pedm.2020.95628"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-014-3391-8"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31678"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.21281"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.21231"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines9080886"}],"container-title":["Journal of Pediatric Gastroenterology and Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jpn3.70394","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jpn3.70394","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jpn3.70394","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T10:14:27Z","timestamp":1778148867000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jpn3.70394"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,10]]},"references-count":12,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/jpn3.70394"],"URL":"https:\/\/doi.org\/10.1002\/jpn3.70394","archive":["Portico"],"relation":{},"ISSN":["0277-2116","1536-4801"],"issn-type":[{"value":"0277-2116","type":"print"},{"value":"1536-4801","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,10]]}}}