Clinical profile and outcome of children presenting with diabetic ketoacidosis at a tertiary care hospital in Dakshina Kannada

Sejal J. Panakkal; Diksha Shirodkar; Praksh R. M. Saldanha

doi:10.18203/2349-3291.ijcp20231048

Authors

Sejal J. Panakkal Department of Paediatrics, Yenepoya Medical College, Mangalore, Karnataka, India
Diksha Shirodkar Department of Paediatrics, Yenepoya Medical College, Mangalore, Karnataka, India
Praksh R. M. Saldanha Department of Paediatrics, Yenepoya Medical College, Mangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20231048

Keywords:

Diabetic keto acidosis, Metabolic disorder, HbA1C

Abstract

Background: Diabetic ketoacidosis (DKA) is the most serious metabolic disturbance of type 1 diabetes mellitus (T1DM) and about 25 to 40% of the newly diagnosed T1DM children present with DKA. This research was conducted to study the clinical profile and identify the precipitating factors at time of presentation of DKA and to correlate the type onset of disease with the severity of DKA and the treatment outcome.

Methods: Ambispective record based study of children admitted in in the paediatric ward of a tertiary care hospital with DKA between 01 July 2019 and 31 January 2022.

Results: A total of 19 patients were enrolled and the mean age of presentation was 10.79±4.17 years with a female predominance. The family history of type 2 DM was noted in 73.7% and osmotic symptoms in 68.4% of the patients. 52.6% of the patients presented in severe DKA. Mean HbA1C noted was 15.14±2.74%. Acute Kidney Injury was present in 10.5% of the patients. Pneumonia was the major precipitating factor. The average length of hospital stay was 7.42±3.27 days. There was no significant correlation with the type of onset of T1DM and the treatment outcome. There was a significant reduction in HbA1c (p<0.05) on follow-up.

Conclusions: This study highlights the need for creating awareness, early referral and timely management of T1DM presenting not only in DKA but also during the ambulatory management.

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References

Alemzadeh R, Ali O. Diabetes Mellitus. In: Kliegman RM, Stanson BF, Schor NF, Geme JWS, Behrman RE, Editors. Nelson textbook of pediatrics. 19th ed. Philadelphia. Elsevier. 2012;1968-97.

Faich GA, Fishbein HA, Ellis SE. The epidemiology of diabetic acidosis: a population-basedstudy. Ame J Epidemiol. 1983;117(5):551-8.

Center for Disease Control (CDC). Hospitalizations for diabetic Ketoacidosis: Washington State, 1987- 1989. MMR-Morb Mortal Wkly Rep. 1992;41(44):837-9.

Patel NR. Diabetic Ketoacidosis in the Pediatric Patient. Indian J Pediatr. 2002;69(1):75-7.

Mira SA, Fatani HH, El-Zubeir AG, El-Sabbagh S. Diabetic Ketoacidosis: a report of 123 Saudi diabetics. Saudi Med J. 1987;8(4):364-8.

Ganesh R, Arvind Kumar R, Vasanthi T. Clinical profile and outcome of diabetic ketoacidosis in children. Natl Med J India. 2009;22(1):18-9.

Agarwal N, Dave C, Patel R, Shukla R, Kapoor R, Bajpai A. Factors Associated With Cerebral Edema at Admission in Indian Children with Diabetic Ketoacidosis. Indian Pediatr. 2020;57(4):310-3.

Glaser N, Fritsch M, Priyambada L, Rewers A, Cherubini V, Estrada S, et al. ISPAD clinical practice consensus guidelines 2022: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatrics Diabetes. 2022;23(7):835-56.

Greenbaisum LA. Electrolyte and acid base disorders. In: Kliegman RM, Stanson BF, Schor NF, Geme JWS, Behrman RE, Editors. Nelson textbook of pediatrics. 19th ed. Philadelphia, Elsevier. 2012;212-42.

Svoren BM, Jospe N. Diabetes in children. In: Kleigman RM, Stanton BF, St Geme JW, Schor NF, Behrman RE, editors. Nelson Text book of Pediatrics First South Asian ed. India: Elsevier Publishers. 2016;2769-75.

Razavi Z. Clinical Profile and Outcome of Diabetic Ketoacidosis in Children at Tertiary Care Hospital”. J Evol Med Dent Sci. 2015;25:114-7.

Shaltout AA, Channanath AM, Thanaraj TA. Ketoacidosis at first presentation of type 1 diabetes mellitus among children: a study from Kuwait. Sci Rep. 2016;6:27519.

Basavanthappa SP, Pejaver R, Raghavendra K, Srinivasa V, Suresh Babu MT. Clinical profile and outcome of diabetic ketoacidosis in a tertiary care hospital in South India. Int J Contemp Pediatr. 2015;2:29-31.

Bhardwaj P, Yadav V, Sharma M. Clinical profile and outcome of the children with diabetic ketoacidosis (DKA) in hilly Himalayan state of north India. Int J Res Med Sci. 2017;5:5402.

Myers SR, Glaser NS, Trainor JL. Frequency and risk factors of acute kidney injury during diabetic ketoacidosis in children and association with neurocognitive outcomes. JAMA Netw Open. 2020;3(12):e2025481.

Glaser N, Barnett P, McCaslin I, Nelson D, Trainor J, Louie J, et al. Risk factors for cerebral edema in children with diabetic ketoacidosis. The pediatric emergency medicine collaborative research committee of the American academy of pediatrics. N Engl J Med. 2001;344:264-9.