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Browsing by Author "Maue, Danielle"
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Item Diabetic Ketoacidosis With Refractory Hypokalemia Leading to Cardiac Arrest(Cureus, 2022-03-24) Grout, Sarah; Maue, Danielle; Berrens, Zachary; Swinger, Nathan; Malin, Stefan; Pediatrics, School of MedicineDiabetic ketoacidosis (DKA) is known to cause total body potassium depletion, but during initial presentation, very few patients are hypokalemic, and even fewer patients experience clinical effects. As the correction of acidosis and insulin drive potassium intracellularly, measured serum potassium levels decrease and require repletion. This phenomenon is well described, and severe hypokalemia necessitates delaying insulin therapy. Less well described is the kaliuretic nature of treatments of cerebral edema. We present a case of an adolescent male with new-onset type 2 diabetes who presented in DKA with signs of cerebral edema, hyperosmolarity, and hypokalemia. As insulin and cerebral edema therapy were initiated, his hypokalemia worsened despite significant IV repletion, eventually leading to ventricular tachycardia and cardiac arrest. Over the following 36 hours, the patient received >590 milliequivalents (mEq) of potassium. He was discharged home 12 days after admission without sequelae of his cardiac arrest.Item Vascular thrombosis after pediatric liver transplantation: Is prevention achievable?(Elsevier, 2023) Martinez, Mercedes; Kang, Elise; Beltramo, Fernando; Nares, Michael; Jeyapalan, Asumthia; Alcamo, Alicia; Monde, Alexandra; Ridall, Leslie; Kamath, Sameer; Betters, Kristina; Rowan, Courtney; Mangus, Richard Shane; Kaushik, Shubhi; Zinter, Matt; Resch, Joseph; Maue, Danielle; Pediatrics, School of MedicineBackground: Vascular thromboses (VT) are life-threatening events after pediatric liver transplantation (LT). Single-center studies have identified risk factors for intra-abdominal VT, but large-scale pediatric studies are lacking. Methods: This multicenter retrospective cohort study of isolated pediatric LT recipients assessed pre- and perioperative variables to determine VT risk factors and anticoagulation-associated bleeding complications. Results: Within seven postoperative days, 31/331 (9.37%) patients developed intra-abdominal VT. Open fascia occurred more commonly in patients with VT (51.61 vs 23.33%) and remained the only independent risk factor in multivariable analysis (OR = 2.84, p = 0.012). Patients with VT received more blood products (83.87 vs 50.00%), had significantly higher rates of graft loss (22.58 vs 1.33%), infection (50.00 vs 20.60%), and unplanned return to the operating room (70.97 vs 16.44%) compared to those without VT. The risk of bleeding was similar (p = 0.2) between patients on and off anticoagulation. Conclusions: Prophylactic anticoagulation did not increase bleeding complications in this cohort. The only independent factor associated with VT was open fascia, likely a graft/recipient size mismatch surrogate, supporting the need to improve surgical techniques to prevent VT that may not be modifiable with anticoagulation.