• Laura K Gonzalez, Sonali Malhotra, Marla Levine, and Elka Jacobson-Dickman.
• From the *Division of Pediatric Emergency Medicine, Department of Emergency Medicine, and †Division of Pediatric Endocrinology, Department of Pediatrics, Maimonides Medical Center, Brooklyn, NY.
• Pediatr Emerg Care. 2017 Aug 1; 33 (8): e27-e29.

AbstractHerein, we report a case of a 12-year-old girl who presented with diabetic ketoacidosis and a leukemoid reaction. Although this association has been described in a few adult patients, pediatric cases have not been reported. A leukemoid reaction is commonly defined as an elevation in the white blood cell count greater than 50,000/μL in response to severe illness or stress other than hematologic malignancy; it is considered to be mediated by various hormones, cytokines, and factors that are released in response to inciting triggers, such as acidosis. As highlighted in our report, distinguishing a benign leukemoid reaction from a hematologic malignancy and even tumor lysis syndrome, particularly in a setting of diabetic ketoacidosis, is crucial to ensuring safe and efficacious therapeutic interventions.

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