Risk factors for poor outcome in diabetic keto acidosis at the initial presentation among children with type 1 diabetes mellitus


  • Merceline Alice PonJeba J. Department of Pediatrics, Government Tirunelveli Medical College and Hospital, Tirunelveli, Tamil Nadu, India
  • Poovazhagi Varadarajan Department of Pediatrics, Government Medical College, Omandurar Government Estate, Chennai, Tamil Nadu, India




DKA, T1DM, Risk factors, Mortality


Background: Diabetic keto acidosis (DKA) is a serious metabolic disorder among children with new onset Type 1 Diabetes mellitus and is associated with high morbidity and mortality. Objective of the present study was to assess the risk factors associated with mortality in DKA at its initial presentation among children with new onset type 1 diabetes mellitus (T1DM).

Methods: A case control study was designed and conducted in the Institute of child Health and Hospital for children, Madras Medical College, Chennai from February 2013 to February 2015. All children admitted with DKA as initial presentation of type 1 Diabetes mellitus were enrolled for this study.

Results: Out of 72 new cases of T1DM, diagnosed during the study period 47 children had DKA and 25 children presented without DKA. Of the 47 children 6 children died. On comparing risk factors for mortality in DKA at the initial presentation, delayed treatment(p-0.002), altered sensorium at presentation(p-0.04), high urea(p-0.014) creatinine(p-0.042), lower bicarbonates (p-0.035), higher sodium(p-0.025) and lower pH(p-0.009) were found to be significantly associated with mortality. Overall mortality in DKA at its initial presentation is 12.8%.

Conclusions: Delay in therapy for DKA and presence of features of severe disease at admission are significant risk factors for mortality.


International Diabetes Federation. IDF Diabetes Atlas. 7th Edition, 2015. Available at www.diabetesatlas.org.

Vjosa M K, Nijazi G, Halim T. Severe ketoacidosis at onset of type 1 diabetes in children due to late diagnosis. Diabetol Croatica. 2007;36-3:59-65.

Vanelli M, Chiari G, Ghizzoni L, Costi G, Giacalone T, Chiarelli F. Effectiveness of a prevention program for diabetic ketoacidosis in children. An 8-year study in schools and private practices. Diab Care. 1999;22(1):7-9.

Levitsky L, Ekwo E, Goselink CA, Solomon EL, Aceto T. Death from diabetes (DM) in hospitalized children (1970-1998) Pediatr Res.1991;29.

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.

Lawrence SE, Cummings EA, Gaboury I, Daneman D. Population-based study of incidence and risk factors for cerebral edema in pediatric diabetic ketoacidosis. J Pediatr. 2005;146:688-92.

Curtis JR, To T, Muirhead S, Cummings E, Daneman D. Recent trends in hospitalization for diabetic ketoacidosis in ontario children. Diab Care. 2002;25:1591-6.

Jayashree M, Singhi S. Diabetic ketoacidosis: predictors of outcome in a pediatric intensive care unit of a developing country. Pediatr Crit Care Med. 2004;5:427-33.

Lone SW, Siddiqui EU, Muhammed F, Atta I, Ibrahim MN, Raza J. Frequency, clinical characteristics and outcome of diabetic ketoacidosis in children with type-1 diabetes at a tertiary care hospital. J Pak Med Assoc. 2010;60:725-9.

Syed M, Khawaja FB, Saleem T, Khalid U, Rashid A, Humayun KN. Clinical profile and outcomes of paediatric patients with diabetic ketoacidosis at a tertiary care hospital in Pakistan. J Pak Med Assoc. 2011;61:1082-7.

Zabeen B, Nahar J, Mohsin F, Azad K, Nahar N. DKA in children: an experience in a tertiary hospital. Ibrahim Medical Coll J. 2008;2:17-20

Kanwal SK, Bando A, Kumar V. Clinical profile of diabetic ketoacidosis in Indian children. Indian J Pediatr. 2012;79:901-4.

Jahagirdar RR, Khadilkar VV, Khadilkar AV, Lalwani SK. Management of diabetic ketoacidosis in PICU. Indian J Pediatr. 2007;74:551-4.

Tiwari LK, Jayashree M, Singhi S. Risk factors for cerebral edema in diabetic ketoacidosis in a developing country: role of fluid refractory shock. Pediatr Crit Care Med. 2012;13:e91-6.

Poovazhagi V, Saradha S. Delayed diagnosis of Diabetic keto acidosis in children-a cause for concern. Int J Diabe Dev Ctries. 2015;35(2):66-70.

Poovazhagi V. Risk factors for mortality in children with diabetic keto acidosis from developing countries. World J Diab. 2014;5(6):932-8.

Poovazhagi V. Factors associated with mortality in children with diabetic ketoacidosis (DKA) in South India. Int J Diab Develop Countries 2016;36(3): 295-302.

Burnet DL, Cooper AJ, Drum ML, Lipton RB. Risk factors for mortality in a diverse cohort of patients with childhood-onset diabetes in Chicago. Diab Care. 2007;30(10): 2559-63.

Steel S, Tibby SM. Paediatric diabetic keto acidosis. Continuing Edu Anaesthesia Crit Care Pain. 2009;9(6):194-9.






Original Research Articles