Diabetic Ketoacidosis Precipitated by Leptospira and Hepatitis: A Management Protocol.

Acute kidney injury (AKI) is a rare but potentially fatal complication of diabetic ketoacidosis (DKA). The associated liver failure and sepsis further challenged the management of DKA. We present a case of an 11-year-old boy presenting with severe DKA being precipitated by hepatitis A virus and leptospira co-infection. The patient presented with severe metabolic acidosis and features of cerebral edema and developed oliguric AKI. In addition, rhabdomyolysis was noted during the course of DKA which probably contributed to the AKI. We, therefore, describe the difficulties faced and the steps taken differently from usual DKA management to manage this case.