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Diabetic ketoacidosis promotes a prothrombotic state
G F Carl1, William H Hoffman, Gregory G Passmore
1Department of Neurology, Veteran's Administration Medical Center, Augusta, Georgia, USA.
Endocrine Research
|April 1, 2003
Summary
Diabetic ketoacidosis (DKA) in children creates a prothrombotic state, increasing stroke risk. Treatment slowly normalizes clotting factors, but elevated von Willebrand factor persists, indicating ongoing vascular activation.
Area of Science:
- Pediatric Endocrinology
- Hematology
- Vascular Biology
Background:
- Cerebrovascular accidents (CVAs) are severe complications in pediatric diabetic ketoacidosis (DKA).
- Understanding DKA's impact on thrombotic factors is crucial for CVA prevention.
Purpose of the Study:
- To investigate the effects of DKA and its treatment on key hemostatic and thrombotic factors in adolescents.
- To evaluate changes in protein C, protein S, von Willebrand factor (vWF), fibrinogen, homocysteine, and folate.
Main Methods:
- Prospective study of seven adolescents with DKA.
- Measurement of thrombotic factors before and at 6, 24, and 120 hours after DKA treatment initiation.
Main Results:
- DKA decreased protein C activity and free protein S levels.
- Von Willebrand factor (vWF) antigen and activity were elevated pre-treatment and vWF activity remained high post-treatment.
- Homocysteine decreased pre-treatment, while folate increased, with reciprocal changes during treatment.
Conclusions:
- DKA and its treatment induce a prothrombotic state characterized by reduced protein C and free protein S, and increased vWF.
- Endothelial activation during DKA contributes to the risk of cerebrovascular accidents in children and adolescents.