@article{3155093,
    title = "Deep Vein Thrombosis and Pulmonary Embolism in a Child with Diabetic
Ketoacidosis and Protein S Deficiency: A Case Report",
    author = "Sdogou, Triantafyllia and Kossiva, Lydia and Kakleas, Kostas and and Platokouki, Helen and Tentolouri, Theodora and Georgouli, Helen and and Karayianni, Christina and Karavanaki, Kyriaki",
    journal = "Hormone Research in Paediatrics",
    year = "2013",
    volume = "79",
    number = "2",
    pages = "114-118",
    publisher = "Karger",
    issn = "1663-2818",
    doi = "10.1159/000343813",
    keywords = "Thrombosis; Thrombophilia; Childhood diabetic ketoacidosis",
    abstract = "Introduction: Diabetic ketoacidosis (DKA) is considered a
hypercoagulable state, which may be exacerbated in patients with
thrombophilia and lead to thrombosis. Case Report: We report on a
5.5-year-old boy, who was admitted to the pediatric department with DKA
due to newly diagnosed type 1 diabetes. Low-grade fever was reported for
6 days prior to admission and continued during DKA management, with
negative septic screening. After DKA management, the child developed
symptoms of iliofemoral deep vein thrombosis (DVT). A family history of
protein S (PS) deficiency was revealed. He was initially treated
intravenously with antibiotics and unfractionated heparin, which, after
2 days, was switched to low-molecular-weight heparin and vitamin K
antagonist (VKA) due to poor anticoagulant response. On the 6th day of
anticoagulant treatment, the patient presented with pulmonary embolism
(PE); he continued with VKA and antibiotics, with significant clinical
improvement. Prolonged fever was attributed to DVT and PE. The patient
was discharged on oral anticoagulants and insulin. Conclusion: We report
on a child with congenital PS deficiency and DKA who developed DVT and
PE despite anticoagulant treatment. It is important in children
presenting with DKA to seek thoroughly for a medical history of
thrombophilia and to start early thromboprophylaxis in such cases in
order to prevent a possible thrombosis. Copyright (C) 2013 S. Karger AG,
Basel"
}