Volume: 6 Issue: 1
Year: 2018, Page: 61-65,
Introduction: Diabetic ketoacidosis is a potentially life threatening acute complication of type 1 diabetes mellitus,characterised by triad of hyperglycemia,ketosis and acidemia,accounting for a majority of deaths related to diabetes in children. Diabetic ketoacidosis is a fatal acute metabolic complication of diabetes mellitus with heterogeneous clinical presentation . Poor compliance was associated with severity of Diabetic Ketoacidosis and infection precipitate the Diabetic Ketoacidosis easily.
Aims & Obective : The present study helps to determine clinical profile and outcome of diabetic ketoacidosis in children.
Materials & Methods : It is a retrospective clinical study of children under 15years of age admitted in PICU at tertiary care center, for a period of one year 2016 January to 2017 January.Children are evaluated through detailed clinical history and laboratory investigations.Among all children admitted 10 children have diabetic ketoacidosis.We selected all children admitted in pediatric intensive care unit of 565 admissions out of 10 cases were diabetic ketoacidosis,in which 9 out of 10 cases were newly diagnosed.90% cases were newly diagnosed and 10% due to omission of insulin resulting in diabetic keto acidosis.
We describe the clinical profile and outcome of diabetic ketoacidosis in children seen in tertiary care centre over a 1-year period. All subjects admitted in pediatric intensive care were reviewed for type 1 diabetes.Data retrieved include age, sex, family history, clinical features, and anthropometry studied about presenting complaints,precipitating factors,course of illness in the hospital, management,outcome of diabetic ketoacidosis cases by using standard protocols for treatment of diabetic ketoacidosis.Diagnosis was made by the presence of hyperglycemia (Blood sugar >250 mg), acidosis (Arterial pH≤7.3) serum carbonate (≤15 mEq) and ketonemia. All relevant investigations were performed and patients were treated with the aim to achieve ketone free condition and euglycemia.
Out of 565 pediatric intensive care unit admissions from January 2016 to January 2017, a total of 10 children presented with DKA (a prevalence of 1 in 56 hospital admissions). The median age at presentation was 7.6years (range: 9 months to 14 years) with a male:female ratio of 1:4; the mean duration of symptoms before hospitalization was 11.6 days (range: 1–30 days).9 out of 10 cases were newly diagnosed DM.9 out of 10 cases presented with respiratory distress, acidotic breathing. Fever was the precipitating factor in 6 children (60%) and in 1 child with type 1 diabetes, the omission of insulin led to DKA. The most common presenting complaints were polyuria and polydipsia in 7, loss of weight in 2, polyphagia and fever in 7 each, and vomiting and abdominal pain in 5. A majority (7) presented with severe DKA, 3 with moderate DKA.
Conclusion : There is need among physicians to educate patients regarding need for regular follow up, proper adherence to treatment and management during an intercurrent illness, as DKA is potentially preventable complication.The outcome of active management using standard protocols of diabetic ketoacidosis in children is excellent . The use of a standard protocol for management was associated with no complications and with zero mortality in this study
Keywords: Diabetic ketoacidosis,children,clinical profile,outcome
1. Nelson textbook of pediatrics 21st edition.2769-2774.
2. Umpierrez GE, Khajavi M, Kitabchi AE. Review: Diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome. Am J Med Sci ;311: 225–33.
3. Curtis JR, To T, Muirhead S, Cummings E, Daneman D. Recent trends in hospitalization for diabetic ketoacidosis in Ontario children. Diabetes Care 2012;25:1591–6.
4. Edge JA, Ford-Adams ME, Dunger DB. Causes of death in children with insulin dependent diabetes 1990–96. Arch Dis Child 1999;81:318–23.
5. Dunger DB, Sperling MA, Acerini CL, Bohn DJ, Daneman D, Danne TP, et al. ESPE/ LWPES consensus statement on diabetic ketoacidosis in children and adolescents. Arch Dis Child 2014;89:188–94.
6. Ganesh R, Suresh N, Ramesh J. Diabetic ketoacidosis in children. Natl Med J India 2008;19:155–8.
7. Jayashree M, Singhi S. Diabetic ketoacidosis: Predictors of outcome in a pediatric intensive care unit of a developing country. Pediatr Crit Care Med 2014;5:427– 33.
8. Jahagirdar RR, Khadilkar VV, Khadilkar AV, Lalwani SK. Management of diabetic ketoacidosis in PICU. Indian J Pediatr 2007;74:551–4.
9. Neu A, Willasch A, Ehehalt S, Hub R, Ranke MB. Ketoacidosis at onset of type 1 diabetes mellitus in children—frequency and clinical presentation. Pediatr Diabetes 2003;4:77–81.
10. Mathai S, Raghupathy P. Fluid and electrolyte management of endocrine disorders in childhood. Indian J Practical Pediatr 2004;6:65–75.
11. American diabetes association.Type 2 diabetes in children and adolescents.Diabetes care.2000;23:381-9.
12. Edge J,Ford-Adams M ,Dunger D.causes of death in children with insulin dependent diabetes 1990-96.Arch Dis Child.1999;81:318-23.
13. Agus MSD,Wolfsdorf JI.Diabetic ketoacidosis in children.Pediatr clin N Am.2005;10:33-7.
14. Fleckman AM.Diabetic ketoacidosis.Endocrinol Metab Clin North Am.1993;22:181-207.
15. Dunger DB,sperling MA,Acerini CL,et al.European society for pediatric Endocrinology 2004;113:e133-40.
Harish G V,Panduranaga G. Clinical profile and outcome of Diabetic ketoacidosis in children.Perspectives in Medical Research 2018;6(1):61-65.