{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T09:20:01Z","timestamp":1787649601318,"version":"build-2736575974"},"reference-count":10,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Diabetic ketoacidosis (DKA) is a common presentation of new-onset type 1 diabetes mellitus in children; however, severe DKA complicated by acute pancreatitis, dialysis-requiring acute kidney injury (AKI), severe hypertension, and neurological involvement is uncommon. Early recognition of these complications is essential because they may substantially increase morbidity and complicate standard DKA management; Case Presentation: An 11-year-old Saudi girl with morbid obesity (BMI 43 kg\/m2), previously in good health, was brought to the emergency department after being found semi-conscious. She had experienced intermittent abdominal pain for five weeks and vomiting for four days. On presentation, she was critically ill, dehydrated, and confused (Glasgow Coma Scale 11\/15) and exhibited Kussmaul breathing and abdominal tenderness. Laboratory investigations confirmed severe new-onset DKA, with a blood glucose level of 684 mg\/dL, pH &lt; 7.0, HbA1c 12.2% and an anion gap &gt; 37 mEq\/L. Despite standard DKA management, metabolic acidosis persisted and renal function progressively deteriorated, accompanied by oliguria and severe hypertension reaching 200 mmHg. By day 4, the patient developed anuria and marked creatinine elevation to 560 \u00b5mol\/L. Brain magnetic resonance imaging demonstrated cerebral microhemorrhages in the setting of multifactorial encephalopathy. Continuous kidney replacement therapy was initiated for KDIGO stage 3 AKI with refractory metabolic acidosis. Autoimmune testing supported the diagnosis of type 1 diabetes mellitus, while renal biopsy demonstrated acute tubular injury; Conclusions: This case highlights a rare, severe multisystem presentation of pediatric DKA. Close monitoring for renal, neurological, pancreatic, and hypertensive complications is crucial, particularly when the clinical course does not improve as expected with standard therapy.<\/jats:p>","DOI":"10.3390\/reports9030283","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T08:00:48Z","timestamp":1787644848000},"page":"283","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Severe Pediatric Diabetic Ketoacidosis Complicated by Dialysis-Requiring Acute Tubular Injury, in a Child Newly Diagnosed with Type 1 Diabetes Mellitus: A Case Report"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6924-4640","authenticated-orcid":false,"given":"Ali","family":"Alamer","sequence":"first","affiliation":[{"name":"Pediatric Intensive Care Unit, Almoosa Specialist Hospital, Al-Ahsa 31982, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7447-4191","authenticated-orcid":false,"given":"Sajjad","family":"Alkadhem","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Almoosa Specialist Hospital, Al-Ahsa 31982, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2082-7681","authenticated-orcid":false,"given":"Osama","family":"Kattih","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Almoosa Specialist Hospital, Al-Ahsa 31982, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Al-Amoudi","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Almoosa Specialist Hospital, Al-Ahsa 31982, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aida","family":"Al Jabri","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Almoosa Specialist Hospital, Al-Ahsa 31982, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maali","family":"Alali","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Almoosa Specialist Hospital, Al-Ahsa 31982, Saudi Arabia"},{"name":"Pediatric Department, Saudi German Hospital, Dammam 32313, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Soliman","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Almoosa Specialist Hospital, Al-Ahsa 31982, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1111\/pedi.13406","article-title":"ISPAD Clinical Practice Consensus Guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state","volume":"23","author":"Glaser","year":"2022","journal-title":"Pediatr. Diabetes"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e170020","DOI":"10.1001\/jamapediatrics.2017.0020","article-title":"Acute kidney injury in children with type 1 diabetes hospitalized for diabetic ketoacidosis","volume":"171","author":"Hursh","year":"2017","journal-title":"JAMA Pediatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e2025481","DOI":"10.1001\/jamanetworkopen.2020.25481","article-title":"Frequency and risk factors of acute kidney injury during diabetic ketoacidosis in children and association with neurocognitive outcomes","volume":"3","author":"Myers","year":"2020","journal-title":"JAMA Netw. 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Kidney J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2817","DOI":"10.1007\/s00467-022-05864-z","article-title":"Current practices in pediatric continuous kidney replacement therapy: A systematic review-guided multinational modified Delphi consensus study","volume":"38","author":"Fuhrman","year":"2023","journal-title":"Pediatr. Nephrol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e2349871","DOI":"10.1001\/jamanetworkopen.2023.49871","article-title":"Time to continuous renal replacement therapy initiation and 90-day major adverse kidney events in children and young adults","volume":"7","author":"Gist","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1038\/s41390-025-03965-7","article-title":"Long-term follow-up strategies for children after severe acute kidney injury","volume":"98","author":"Ceschia","year":"2025","journal-title":"Pediatr. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s13613-019-0563-2","article-title":"Diagnosis and management of metabolic acidosis: Guidelines from a French expert panel","volume":"9","author":"Jung","year":"2019","journal-title":"Ann. 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