A 5-year-old with new-onset diabetes presenting with ketoacidosis, acute pancreatitis, and renal failure.

A 5-year-old girl presented to the emergency room with altered mental status secondary to severe diabetic ketoacidosis due to new-onset GAD65 antibody positive, type 1 diabetes mellitus. On hospital day 0, she developed anuria, shock, and hypertriglyceridemia-associated acute pancreatitis. Following intravenous insulin therapy, the patient's ketoacidosis improved. Her other complications persisted for several days and improved only with significant fluid resuscitation and supportive interventions, including intubation, thoracostomy, and vasopressors. This case underscores the importance of recognizing the early warning signs of diabetic ketoacidosis and reviews how to appropriately manage its associated life-threatening complications.