Diabetic ketoacidosis in a pediatric intensive care unit

Lopes, Clarice Laroque Sinott; Pinheiro, Paula Pitta; Barberena, Luzia S.; Eckert, Guilherme Unchalo

doi:10.1016/j.jped.2016.05.008

Cited by 23 publications

(26 citation statements)

References 11 publications

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“…Mean age at presentation was 9.048 ± 3.24. In the study by Adriana Yock-Corrales et al, 16 the mean age at presentation was 8.6 ± 3.78 and it was 10.2 ± 2.9 in the study by Clarice L. S. Lopes et al 17 Our study shows no association between age and the severity of DKA. As ours is a government teaching hospital, majority of the patients admitted were from lower socioeconomic class (73.1%).…”

Section: Graph 1 Profile Of Symptomscontrasting

confidence: 48%

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Diabetic Ketoacidosis in Children- Clinical Profile and Outcome

Padma¹,

Antony²

2017

jebmh

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BACKGROUND Diabetic ketoacidosis is a potentially life-threatening condition, which accounts for the majority of diabetes-related morbidity and mortality in children with type 1 diabetes mellitus. Early diagnosis and prompt management substantially reduces the mortality. The aim of the study is to assess the clinical characteristics and early outcome in children with diabetic ketoacidosis. MATERIALS AND METHODS This is a descriptive study done in a tertiary care hospital. Fifty two episodes of diabetic ketoacidosis in children of age ≤12 years admitted during the period 2011 to 2016 were included in the study. Clinical details, investigations and complications were recorded in a pro forma and data was analysed using statistical tests. RESULTS Fifty two episodes of diabetic ketoacidosis were included in the study. Thirty three (63.5%) children presented with DKA at first diagnosis of diabetes, whereas 19 (36.5%) were DKA among children with established diabetes. Mean age at presentation was 9.048 ± 3.24. Female-to-male ratio was (1.36:1). The mean duration of onset of symptom before hospitalisation was 10.10 ± 9.52. Most commonly observed presenting symptoms were polyuria (63.46%), polydipsia (65.38%), tiredness (61.54%), vomiting (36.54%) and pain abdomen (32.69%). Mild DKA occurred frequently than moderate and severe forms. Among these children, 40.4% had infection as the predisposing factor. Demographic variables like age, gender, socioeconomic status, family history of diabetes did not have any significant association with the severity of DKA. The clinical parameters like tachypnoea, Kussmaul breathing, shock, altered sensorium at presentation and dehydration had significant association with the severity of DKA. Similarly, hypoglycaemia, hypokalaemia, hyponatraemia, acute kidney injury and cerebral oedema had significant association with the severity of DKA. All the patients recovered with therapy. No mortality was reported. CONCLUSION Diabetic ketoacidosis can be the initial presentation of diabetes mellitus or can occur in children with established diabetes mellitus. The mortality can be reduced by timely diagnosis and proper management. Diabetes education programs and follow up care of the patients should be strengthened to reduce the incidence of DKA.

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Section: Graph 1 Profile Of Symptomscontrasting

confidence: 48%

“…Hypoglycaemia as a complication of treatment was observed in 26.92% cases, slightly higher than that observed in other studies. 17 Electrolyte disturbances seen were hypokalaemia and hyponatraemia. Potassium is usually lost as a result of vomiting, osmotic diuresis and secondary hyperaldosteronism due to volume depletion.…”

Section: Physical Signsmentioning

confidence: 99%

Diabetic Ketoacidosis in Children- Clinical Profile and Outcome

Padma¹,

Antony²

2017

jebmh

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“…Some studies found that cerebral edema, pulmonary edema and septic shock were predictors of mortality [10][11][12].…”

Section: Discussionmentioning

confidence: 99%

Diabetes Keto-acidosis in Children: A Report of Two Cases and Literature Review

Mande

Batina

Alworonga

et al. 2019

AJPR

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Aims: To present features of two cases of diabetes keto-acidosis observed in the Nouveau Village de Pédiatrie, Democratic Republic of Congo (DRC), between 2014 and 2018. Cases Presentation: The first case was a male patient, 13 years-old, who arrived with fever, vomiting, polyuria, unconsciousness, respiratory distress and coma. His fasting plasma glucose was 570 mg/dl. Urea nitrogen 56,4 mg/dl; Creatinine 2,1 mg/dl. C reactive protein was 27 mg/l. The treatment of diabetes ketoacidosis (DKA) was based on insulin, fluids and antibiotics. Despite glycemic normalization, he died with cerebral edema and sepsis. The second case was a female child of 6 years, received with fever, polydipsia, asthenia, polyuria, a familial history of diabetes. Random plasma glucose was 500 mg/dl and C reactive protein 10 mg/l. Despite insulin and antibiotics, her clinical state worsened by a pyelonephritis and pulmonary edema and, probably tuberculosis. She also died. Conclusion: Diabetes mellitus type 1 in children, complicated with DKA and sepsis, have worse prognosis. More children death would be avoidable by correct global treatment including insulin and hydro-electrolytic balance to prevent cerebral or pulmonary edema. Children with tuberculosis should realize routine screening for diabetes mellitus and inversely.

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“…In the long term, the metabolic derangements of diabetes are associated with increased risks of micro-and macrovascular complications [10]. In childhood, diabetic ketoacidosis leads to hospitalization [11], including ICU admission [12], but the incidence of ICU admission with Type 1 diabetes is unknown, particularly in adulthood. The reasons for admission, and outcomes after admission are also unknown.…”

Section: Introductionmentioning

confidence: 99%