Acute Respiratory Distress Syndrome: A Rare Complication in Pediatric Diabetic Ketoacidosis

Sudhanshu, Siddhnath; Jevalikar, Ganesh; Das, Pravin Kumar; Singh, Pramod Kumar; Bhatia, Eesh; Bhatia, Vijayalakshmi

doi:10.1007/s12098-015-1961-6

Cited by 7 publications

(5 citation statements)

References 10 publications

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“…The mortality rate from DKA in children is 0.15%-0.30% and the major cause that accounts for 60%-90% of all DKA deaths is cerebral edema ( 8 ). Among other causes of mortality and morbidity, ARDS also presents a predictor of high mortality but this entity is rarely encountered in pediatric population ( 8 , 10 , 11 ). The true mechanism of ARDS during DKA remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…It can be speculated that severe acidosis as in our patient with DKA could cause an increase in the permeability of capillary membranes, leading to alteration of the alveolar surfactant metabolism ( 4 ). However, many patients are very acidotic at the onset of DKA but only few of them develop ARDS ( 11 ). This supports the hypothesis of the multifactorial etiology of ARDS as a complication of DKA ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

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Acute Respiratory Distress Syndrome in a Four-Year-Old Boy with Diabetic Ketoacidosis – Case Report

Pavić

Drinković

Galić

et al. 2018

ACC

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SUMMARY – Among many disease states as known initiators of acute respiratory distress syndrome (ARDS), diabetic ketoacidosis (DKA) is the rarest one. We present a 4-year-old boy with DKA as the first manifestation of insulin-dependent diabetes mellitus who developed ARDS, required tracheal intubation and mechanical ventilation, and survived without significant sequels. To improve survival of patients with ARDS as a complication of DKA, physicians should be aware of this rare pulmonary complication and its appropriate management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute Respiratory Distress Syndrome in a Four-Year-Old Boy with Diabetic Ketoacidosis – Case Report

Pavić

Drinković

Galić

et al. 2018

ACC

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“…Previous studies also revealed the independent association of severe respiratory distress followed by hypoxemic respiratory failure with cerebral edema 19 and diabetic ketoacidosis-related cerebral edema. 20 A number of previous studies also showed that severe sepsis and its cascades are associated with cerebral edema. 21 We treated the study children with cerebral edema either with mannitol or 3% NaCl.…”

Section: Discussionmentioning

confidence: 97%

Factors associated with cerebral edema in children under 5 years of age admitted in an intensive care unit and their outcome

et al. 2019

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Objective: We aimed to evaluate risk factors and outcome of cerebral edema in children with diarrhea. Methods: In this retrospective chart analysis, data of all diarrheal children under 5 years of age having convulsion and admitted in intensive care unit were retrieved from an electronic medical record system of Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh, from 1st January 2011 to 31st December 2016. Comparison of clinical and laboratory characteristics was made between children with (cases = 22) and without cerebral edema (controls = 66). Results: Cases more often had a fatal outcome than controls (36% vs 8%, p = 0.003). In logistic regression analysis, after adjusting for potential confounders, the cases were independently associated with respiratory distress (odds ratio = 5.5, confidence interval = 1.55–19.62, p = 0.008), severe sepsis (odds ratio = 4.6, confidence interval = 1.24–16.77, p = 0.022), and severe malnutrition (odds ratio = 0.16, confidence interval = 0.04–0.74, p = 0.019). A rapid drop (>0.5 mmol/L per hour) in serum sodium did not have any impact on developing cerebral edema (p = 0.090). Conclusion: Identification of simple clinical predictors may help in the early treatment of cerebral edema that may further help in reducing deaths in such children especially in resource-poor settings. However, further research with prospective design is needed to consolidate our observation.

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“…However, with an increase in the number of hospitalizations in DKA over the years, up to 27% of cases were found to be from type 2 diabetes [4]. The major clinical difference between these two types of diabetes is a lesser degree of acidosis and absence of hyperkalemia in type 2 diabetes [5].…”

Section: Discussionmentioning

confidence: 99%

A Case of Concomitant COVID-19 Infection-Induced Acute Respiratory Distress Syndrome and Diabetic Ketoacidosis: Another Challenge in Fluid Management

Panjawatanan

Jha

Hughes

et al. 2021

Journal of the Endocrine Society

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Background: Coronavirus Disease 2019 (COVID-19) has been announced as a pandemic worldwide. The respiratory tract is a target organ-system which can result in serious complications like acute respiratory distress syndrome (ARDS). Management of this condition is more challenging in diabetes who developed diabetic ketoacidosis (DKA). Clinical Case: We report a case of a 59-year-old male who presented with 4 days of productive cough with blood-tinged sputum, shortness of breath, and chills. Patient had decreased oral intake and had not been compliant with his medication. He had underlying disease significant for type 2 diabetes, essential hypertension, obesity (BMI 32 kg/m2), history of pancreatitis and diabetic ketoacidosis. His diabetes medications included insulin degludec 126 units with insulin lispro sliding scale, dulaglutide, metformin, and sitagliptin. On examination, the patient was lethargic. Initial vital signs included a temperature of 36.8°C, respiratory rate 24/min, heart rate 65 bpm, BP 140/67 mmHg, and oxygen saturation 91% on room air. Lung auscultation revealed bilateral widespread crackles. Laboratory was significant for glucose 387 mg/dL (70–139), pH 7.25 (7.35-7.28), anion gap 15.8 mEq/L (6–14) and concurrent normal gap acidosis, urine ketones 15 mg/dL (negative), and LDH 325 U/L (140–171). An initial chest x-ray showed bilateral peripheral pulmonary infiltrates. Workup was negative for influenza, pneumococcus, and legionella. The patient was subsequently intubated on the first day for worsening hypoxia due to severe ARDS (PaO2/FiO2 ratio of 71). He was concomitantly treated for DKA and hypotension with intravenous insulin, initially started at 12 units/hour with subsequent titration down to average of 5 units/hour, fluid resuscitation (approximate 34 ml/kg actual body weight) and, potassium repletion on the first day. On the same day, his hypoxia worsened with an increase in pulmonary infiltrates, so we stopped intravenous fluids and initiated norepinephrine for 24 hours. His mechanical ventilation settings followed ARDS guidelines. Positive COVID-19 was detected from real-time RT-PCR. After maintaining a negative fluid balance, we were able to extubate in 72 hours. Intravenous insulin was continued for 46 hours then was switched to subcutaneous basal-bolus regimen. He was discharged with insulin degludec 100 units with insulin lispro sliding scale, metformin, and sitagliptin. Dulaglutide was held. Conclusion: Type 2 diabetes are rarely affected by DKA but can be found in up to 27% of the cases. There are reports of ARDS as a serious complication in severe DKA in adults and children, yet no data for concomitant DKA and ARDS has been published. We propose that the management of DKA in COVID-19 patients with ARDS may be similar to the paradigm utilized for other volume restriction in patients with congestive heart failure and end-stage renal failure.

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Acute Respiratory Distress Syndrome: A Rare Complication in Pediatric Diabetic Ketoacidosis

Cited by 7 publications

References 10 publications

Acute Respiratory Distress Syndrome in a Four-Year-Old Boy with Diabetic Ketoacidosis – Case Report

Acute Respiratory Distress Syndrome in a Four-Year-Old Boy with Diabetic Ketoacidosis – Case Report

Factors associated with cerebral edema in children under 5 years of age admitted in an intensive care unit and their outcome

A Case of Concomitant COVID-19 Infection-Induced Acute Respiratory Distress Syndrome and Diabetic Ketoacidosis: Another Challenge in Fluid Management

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