A case report of leukemoid reaction in a child with severe diabetic ketoacidosis (DKA) and cerebral edema: When rarity and complexity meet.

Key Clinical Message: In pediatrics, a leukemoid reaction in severe DKA cases with cerebral edema has never been reported. The fluid management was challenging as it required balancing rates to ensure improvement of the condition while preventing neurological sequelae.

Abstract: The combination of diabetic ketoacidosis (DKA), cerebral edema, and leukemoid reaction in pediatrics has never been reported before in the literature. It may lead to significant morbidity and high mortality. Here, we report a case of DKA-induced cerebral edema associated with severe leukocytosis (WBC 98 × 10/L), which had many challenges in fluid therapy.