Unresponsive and refractory hypokalemia in celiac crisis- A predictor of high mortality

Year 2015, Volume: 7 , - , 07.01.2015

Sudhir Mehta , Jenisha Jain Swati Mulye

Abstract

                                 Celiac disease is an immune mediated disorder elicited by the ingestion of gluten in genetically susceptible person and associated with some HLA subtypes. It is characterized by chronic inflammation of small intestine associated with villous atrophy. Symptoms usually appear when weaning from breast milk is done and gluten is introduced in diet. Failure to thrive, chronic diarrhea, vomiting abdominal distension are usual symptoms. Celiac crisis is rare but well known complication of celiac disease presenting with various systemic and metabolic manifestations like hypokalemia, hyponatremia, shock and bleeding diathesis. Celiac crisis usually has some underlying precipitating factor and is more common in patient with noncompliance with gluten free diet. We report a case of 14 year old female child, a known case of celiac disease having the poor compliancewith gluten free diet, presenting in celiac crisis with shock, refractory hypokalemia and bleeding diathesis.

Keywords

Celiac crisis, Refractory hypokalemia, high mortality

References

• Farrell RJ ,Kelly CP. Celic sprue. N Engl J Med 2002; 346: 180-188.
• Baranwal AK, Singhi SC, Thapa BR, et al. Celiac crisis. Indian Pediatr 2003; 70: 433- 435.
• Steens RF, Csizmadia CG, Georage EK, et al. A national prospective on childhood celiac disease in Netherlands 1993-2000: An increasing recognition and a changing clinical picture. J Pediatr 2005; 147: 239- 243.
• Puri AS, Garg S, Monga R,et al. Spectrum of Atypical celiac disease in North Indian Children. Indian Pediatr 2004; 41: 822-827.
• Hill ID, Dirks MH, Liptak GS, et al. Guidelines for diagnosis and treatment of celiac disease in children: Recommendations of North American society for Pediatric Gasteroenterology, Nutrition. J Pediatr Gastroenteral Nutr 2005; 40: 1-19. Hepatology and
• Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum. J Gastroenterol 2001; 120: 636-651.
• Lloydstill Jd, Grand Rj ,Khaw KT, et al. The use of corticosteroids in celiac criss. J Pediatr 1972; 81: 1074-1081.
• Walia A, Thapa BR. Celiac crisis. Indian Pediatr 2005; 42: 116-119.