Diabetic ketoacidosis (DKA) associated with rhabdomyolysis has been reported previously though such cases have been rare and the exact pathophysiology yet unclear. We came across a 16-year-old female with type 1 diabetes. She presented with severe dehydration, lethargy, respiratory distress, and oliguria, which worsened to anuria. Laboratory investigations demonstrated a hyperglycaemic hyperosmolar state (HHS). A diagnosis of DKA with ARF was made. The clinical signs prompted further investigations, which confirmed rhabdomyolysis and hypophosphatemia. The patient suffered a sudden cardiac arrest due to severe electrolyte imbalance and subsequent arrhythmia due to rhabdomyolysis. She was resuscitated and underwent hemodialysis. The patient's clinical condition improved as laboratory parameters normalized; she was weaned off the ventilator and no longer required hemodialysis. Considering the non-compliance to insulin and unhealthy lifestyle, and the adverse psychological impact of the events preceding cardiac arrest, she was managed with a multidisciplinary approach, thus facilitating clinical, psychological, and behavioural improvement. Thus, long-standing T1D with uncontrolled blood glucose increases the risk of malnutrition, electrolyte imbalance, and metabolic irregularities, increasing the susceptibility to DKA and subsequent rhabdomyolysis, which can have serious complications such as cardiac arrest. Therefore, a holistic approach using multidisciplinary teams is suggested to reduce morbidity and mortality.
Key words: Diabetic ketoacidosis, acute kidney injury, rhabdomyolysis, cardiac arrest, type 1 diabetes, adolescent
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