Outcome of diabetic ketoacidosis among paediatric patients managed with modified DKA protocol at Tikur Anbessa specialized hospital and Yekatit 12 hospital, Addis Ababa, Ethiopia

Abstract

Introduction Diabetic ketoacidosis (DKA) is a serious acute complication of diabetes mellitus that carries a significant risk of mortality with delayed treatment in low‐resource countries. This study aimed to determine the outcome of paediatric DKA patients' managed with a modified DKA treatment protocol using intermittent bolus subcutaneous insulin administration. Methods A cross‐sectional study design with retrospective data collection was conducted among children younger than 14 years of age admitted from January 2013 to February 2017. A modified protocol was prepared based on a reference from the international society for paediatric and adolescent diabetes and other international guidelines. Data were analysed using Statistical package for social science (SPSS) version 22.0. Descriptive statistics were performed. Binary logistic regression was used to identify associations, and significant variables were further considered for multivariate logistic regression to determine the outcome of DKA patients. Result Among the 190 patients, 55.5% (n = 105) were newly diagnosed. The overall average time required for resolution of DKA was 48 ± 27.8 h. Mental status on presentation (p = .001), shock on presentation (p < .01) and severity of DKA (p < .001) were found to have a significant association with the mean time for clearance of DKA. Hypoglycaemia was the most common treatment‐related complication, which occurred in 23.7% of patients (n = 45) followed by hypokalaemia in 4.3% of patients (n = 8), and no patient developed cerebral oedema and death. Conclusion The time required for clearance of DKA was prolonged, and hypoglyceamia was a common complication for children younger than 5 years of age. The modified protocol of DKA is reasonable management for low‐resource settings with further modification.

Poor treatment outcome and associated factors of hyperglycemic emergencies among diabetic patients in Ethiopia: A systematic review and meta-analysis

“…The highest prevalence of poor treatment outcome is reported from Oromia region (26.2%) [ 20 ] and the least is from Addis Ababa (3.9 %) [ 22 ]. The included studies were conducted from different regions of the country; 2 from Addis Ababa [ 22 , 24 ], 3 from Oromia region [ 11 , 20 , 29 ], 1 from Eastern Ethiopia [ 25 ], 1 from Amhara region [ 23 ] and 1 from Tigray region [ 30 ]. Detailed characteristics of the included studies are presented in ( Table 1 ).…”

“…According to many research conducted in different countries admission serum creatinine >1.2 mg/dl, co-morbidity, rural residents, medical history of stroke, shock on presentation, hypokalemia, severity, type 2 diabetes and sepsis were independent predictors of poor treatment outcome of HEs among diabetic patients [ 11 , [22] , [23] , [24] , [25] ].…”