Frequency, clinical characteristics, biochemical findings and outcomes of DKA at the onset of type-1 DM in young children and adolescents living in a developing country – an experience from a pediatric emergency department

Abstract

Background As per the International Society for Pediatrics and Adolescent Diabetes (ISPAD) census, diabetic ketoacidosis (DKA) is the most frequent cause of diabetes-related death. In developing countries, DKA-related mortality rate ranges from 6% to 24% (Onyiriuka AN, Ifebi E. Ketoacidosis at diagnosis of type 1 diabetes in children and adolescents: frequency and clinical characteristics. J Diabetes Metab Disord 2013;12:47) in contrast to 0.15%–0.31% in the Western world (Poovazhagi V. Risk factors for mortality in children with diabetic ketoacidosis from developing countries. World J Diabetes 2014;5:932–93.). In developing countries like Pakistan, the situation is more perplexing owing to uncertain or under-reported statistics about the spectrum of the disease and its prevalence, coupled with limited access to medical care and experts as well as less awareness. These limitations restrict our ability to develop interventions that are patient-centered. Our main objective was to determine the severity, clinical features, bio-chemical findings and outcomes of DKA in children aged 1 month to 16 years. Subjects and methods This retrospective study included the analysis of medical and laboratory records from patients’ medical charts and the electronic database of all children aged 1 month to 16 years with newly diagnosed type-1 diabetes mellitus (T1DM) complicated with ketoacidosis, who presented to the emergency department (ED) at the Aga Khan University Hospital (AKUH), between January 2009 and December 2014. Results Diabetes mellitus complicated with DKA was the predominant diagnosis (n=113 [75.83%]) among endocrine diseases in children visiting the ED. Our study witnessed an increase in the incidence of DKA particularly after 5 years of age, with more severity in females. In our study, the mortality rate was 3.4%. Conclusions Considering the high incidence and mortality rate, it is emphasized that DKA should be considered in differential diagnosis. An awareness campaign for both general pediatricians and physicians as well as for the public is needed for better outcomes.

Risk factors associated with resolution of diabetic ketoacidosis in pediatric critical care units

“…The dominance of new onset of diabetes of this study might be explained by relatively older age of children who were enrolled in the study. Our results were consistent with the reports from Polish, Pakistanian and Iranian children demostrating the average age groups at the new onset of diabetes 26,29,30 .…”

“…Other studies report the incidence as 8.6% -67% 25,26 . The significantly wide ranges in the reported incidence might be due to several reasons such as: DKA criteria designed for the study, the prevalence of DM in the index population, the socioeconomic income of the country and racial differences 26,27 . Children less than 2 years of age and adolescents between 10 and 14 years have higher DKA prevalence than other age groups 28 .…”

The Effects of Prehospital Care on Outcome in Pediatric Diabetic Ketoacidosis

“…There are several reasons for this. It is the most common emergency in pediatric T1DM and is still the major cause of hospitalization, morbidity, and mortality (1,2,9). Most morbidities and deaths due to DKA take place out of the hospital, presumably from φ Appropriate insulin treatment (type/dose): Low-dose intravenous (iv) insulin infusion rate 0.05 U/kg/hr administered for children who is younger than 5 years old, and 0.1 U/kg/h rate used for children older than 5. severe dehydration and acidosis, which can be treated by iv fluids and insulin.…”

“…Diabetic ketoacidosis (DKA) is one of the serious acute complications of type 1 diabetes mellitus (T1DM). DKA occurs at the onset of diabetes in half of patients (1,2). The annual rate of DKA in pediatric T1DM is 6-8%, with a case fatality rate ranging from 0.15% to 0.31% in developed countries.…”

Frequency and severity of ketoacidosis at diagnosis among childhood type 1 diabetes in Khartoum state, Sudan

“…However, the reported rate in the current study is twice the mortality rate from DKA reported in developed countries 6 and within the range reported in developing countries. 38 In Sudan, the poor socioeconomic status and low parental awareness about the risk factors of developing DKA in T1DM patients could contribute to the observed high mortality rate from DKA. 35 Among the limitations of the current study is that biochemical parameters (like blood urea nitrogen and sodium) were not recorded in the majority of the patients' files.…”