Clinical profile and outcome of the children with diabetic ketoacidosis (DKA) in hilly Himalayan state of north India

Abstract

Background: Context: DKA is an important complication of undiagnosed or poorly controlled diabetes mellitus. Proper management of DKA can prevent morbidity and mortality attributable to diabetes mellitus. The aim of the research was to study the clinical profile and outcome of the children admitted with Diabetic Ketoacidosis (DKA).Methods: A descriptive retrospective study was conducted in pediatric ICU of tertiary level care hospital over three years between January 2013 and December 2015. 29 patients were diagnosed with DKA during the three-year period, the data was collected by reviewing the medical record of the patient and information with respect to personal details, clinical features, laboratory parameters, management and outcome was recorded.Results: 29 patients were diagnosed with DKA, of these 17 were males and 12 females. M:F was 1.4:1 and mean age at presentation was 11.4±4.4 yrs. DKA was the presenting manifestation of Diabetes in 48.2% patients and 51.8% were already known cases of Diabetes. Abdominal pain (62%), polyuria (58.6%), fast breathing (58.6%), vomiting (55.1%), and altered sensorium (44.8%) were common presenting symptoms of DKA. Severe ketoacidosis was noted in 48.2% and severe dehydration in 31%. Shock was observed in 27.5% patients and 20.9% had cerebral edema. Metabolic abnormalities like hponatremia, hypernatremia, hyperkalemia, hypokalemia were seen in 44.8%, 13.7%, 24.1%, 17.2% respectively. We had 1 (3.4%) mortality.Conclusions: Diabetic Ketoacidosis (DKA) is an important cause of hospital admissions and 48.2% of newly diagnosed cases presented with DKA. Infections and omission of the insulin were the most common precipitating factors. For the long- term management strategy it is important to educate of the patients and their parents regarding regular blood sugar monitoring and insulin dosing.

Incidence and predictors of diabetic ketoacidosis among children with diabetes in West and East Gojjam zone referral hospitals Northern Ethiopia, 2019

“…Also, in our study, children who have medication non-adherence were more likely to develop DKA as compared to children who adhere to medication. This nding is supported by other previous studies conducted in sub-Saharan Africa [30], north India [31], Saudi Arabia [32], Southern Iraq [23]. This might be since DM is a chronic illness after taking medication symptoms may disappear for some time so; the children may not take their medication on time.…”

Incidence and predictors of diabetic ketoacidosis among children with diabetes in west and east gojjam zone referral hospitals north west Ethiopia, 2019.

“…Also, in our study, children who have medication non-adherence were more likely to develop DKA as compared to children who adhere to medication. This nding is supported by other previous studies conducted in sub-Saharan Africa [32], north India [33], Saudi Arabia [34], New Zealand [23], Southern Iraq [25]. This might be since DM is a chronic illness after taking medication symptoms may disappear for some time so; the children may not take their medication on time.…”

“…Lastly in this study, children who have preceding gastroenteritis and upper respiratory tract infection at the time of DKA development were more likely to develop DKA as compared to those who have not. This is supported by the study, in Nigeria [10], sub-Saharan Africa [32], Malaysia [35], north India [33], and Saudi Arabia [34]. This might be infection can cause high levels of counteracting hormones mainly cortisol and adrenaline which triggering an episode of DKA.…”

Incidence and predictors of diabetic ketoacidosis among children with diabetes in west and east gojjam zone referral hospitals north west Ethiopia, 2019.

“…Children who have medication non-adherence were more likely to develop DKA as compared to adhere to medication. This nding is supported by other previous studies conducted in sub-Saharan Africa [27] , north India [28] , Saudi Arabia [29] , New Zealand [24] , Southern Iraq [26] . This might be since DM is chronic illness after taking medication symptoms may disappear for some times so, the children may not take their medication on time.…”

“…Children who have preceding gastroenteritis and upper respiratory tract infection at the time of DKA development were more likely to develop DKA as compared to those who have not. This is supported by study in Tikur Ambesa hospital [32] , Nigeria [33] , sub-Saharan Africa [27] , Malaysia [32] , north India [28] and Saudi Arabia [29] . This might be infection can cause high levels of counteracting hormones which triggering an episode of DKA…”