Diabetic Ketoacidosis: Demographic Data, Clinical Profile and Outcome in a Tertiary Care Hospital

Abstract

Background: Diabetic ketoacidosis (DKA) is an acute and life-threatening situation that accounts for the majority of diabetesrelated morbidity and mortality in children and adolescents who suffer from type 1 diabetes mellitus (T1DM). Objectives: To investigate the demographic, clinical characteristics, and outcomes of DKA in young patients with established T1DM and newly diagnosed diabetes in a tertiary referral hospital. Methods: Data from all T1DM patients diagnosed with DKA episodes in the pediatric endocrine unit at Besat university hospital, Hameden, Iran during 2006 -2013 were reviewed in a retrospective study. The data collected includes the demographic data (age, sex, place of residence, first presentation and established T1DM), clinical presentation (main presenting symptoms, average duration of presenting symptoms before hospitalization, precipitating factors, severity of DKA, level of consciousness), laboratory parameters (blood sugar, arterial blood gases, urine ketones, serum electrolytes) and the outcome. DKA was defined as a glucose level higher than 250 mg/dL, pH < 7.30, bicarbonate > 15 mmol/L and ketonuria. Data was entered and analyzed on SPSS version 16. A P value less than 0.05 were defined as statistically significant. Results: The study population comprised 72 children satisfying the inclusion criteria of the study. Mean age of patients was 9.4

Diabetic Ketoacidosis in Children with Type-1 Diabetes in a Tertiary Hospital in Sokoto, North-Western Nigeria: Clinical Profile and Outcome

“…More than three-quarter of the children with DKA were males; similar to the reports from India [26] and Ethiopia [19]. However, the majority of other studies reported female preponderance [5,14,17,24,27]. The reason for this disparity in gender is not clear but could be because infection was a major triggering factor of DKA in our study, similar to the Indian [26] and Ethiopian study [19]; given the biological and genetic vulnerability of males to infection [28], which also tends to be severe in them, thus resulting in infection-caused inflammation, pro-inflammatory cytokine release, and counter-regulatory hormones that lead to insulin resistance/deficiency and metabolic deterioration to DKA [25].…”

“…Diabetic ketoacidosis can occur at disease onset; before T1D is recognised or diagnosed, it can also occur in known patients with T1D (established diabetes), particularly during intercurrent illnesses, and especially, if selfmonitoring is unavailable, insulin is unaffordable or not being provided correctly [4]. Diabetic ketoacidosis may also occur due to poor metabolic control, inappropriate interruption of insulin pump therapy, psychiatric disorders, difficult family circumstances and lower socioeconomic status [5]. There is wide geographic variation in the frequency of DKA at onset of diabetes and rates inversely correlate with regional incidence of TID [3,6].…”

“…There is wide geographic variation in the frequency of DKA at onset of diabetes and rates inversely correlate with regional incidence of TID [3,6]. International studies have reported frequencies of 15 -70% in new onset T1D patients [3,7,8], higher rates of 75-88% were reported in some studies in Nigeria [9][10][11] On the other hand, the risk for DKA in patients with established T1D is 1-10% per patient/year [5,12,13] A study in Enugu, southeast Nigeria reported prevalence of DKA amongst children emergency room admissions of 0.13% (1.3/1000) [14].…”

Is Age a Risk Factor for Cerebral Edema in Children With Diabetic Ketoacidosis? A Literature Review

“…Secondly, we included studies which described both children who had known T1D and those with a new diagnosis of T1D. However, these studies only included a small number of children with non-T1D (33) or with established T1D (45). Thirdly, studies used different age categories (e.g.…”

“…Overall, 20 of 25 studies reported that DKA was more common in children younger than 5 to 6 years of age compared with older children. In contrast, 5 of 25 studies did not find such an association, including 2 retrospective studies from Iran (35,45), 1 retrospective nationwide study from Sweden (28), 1 prospective multicentre European study (24) and 1 study from the United Kingdom that found a higher risk for DKA only in a subgroup of younger children of Asian origin (23).…”