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Prolonged QT interval corrected for heart rate during diabetic ketoacidosis in children
Nathan Kuppermann1, Jeanny Park, Kathryn Glatter
1Department of Emergency Medicine, University of California, Davis, School of Medicine, 2315 Stockton Blvd, PSSB Bldg, Ste 2100, Sacramento, CA 95817, USA. nkuppermann@ucdavis.edu
Insights
Diabetic ketoacidosis (DKA) frequently causes prolonged QTc intervals in children, which resolve after recovery. Cardiac monitoring during DKA is crucial, and screening for other ketotic conditions may be beneficial.
Area of Science:
- Pediatric Cardiology
- Endocrinology
- Critical Care Medicine
Background:
- Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes mellitus.
- Ketosis, a metabolic state characterized by elevated ketone bodies, occurs in DKA and other conditions.
- The cardiac effects of ketosis, particularly QTc interval prolongation, are not well-understood in children.
Purpose of the Study:
- To investigate the impact of diabetic ketoacidosis (DKA) on the corrected QT (QTc) interval in pediatric patients.
- To determine the prevalence and characteristics of QTc prolongation during DKA.
- To assess the correlation between QTc prolongation and clinical variables in children with DKA.
Main Methods:
- An observational study involving electrocardiography performed during DKA and after recovery in pediatric patients.
- Measurement of the QTc interval using the Bazett's formula (QT divided by the square root of the RR interval).
- Correlation analysis of QTc intervals with clinical parameters, including anion gap.
Main Results:
- The mean QTc interval was significantly higher during DKA (450 ms) compared to after recovery (407 ms) (P < .001).
- Nearly half of the children (47%) exhibited QTc prolongation during DKA, with a significant decrease post-recovery.
- The anion gap showed a significant association with QTc prolongation (correlation coefficient, 0.49; P = .006), and electrolyte abnormalities were not the primary cause.
Conclusions:
- Prolonged QTc intervals are common in children experiencing diabetic ketoacidosis (DKA) and are linked to ketosis.
- Strict adherence to current cardiac monitoring guidelines for pediatric DKA is recommended.
- Consideration should be given to electrocardiographic screening for patients with other ketotic conditions.
Objective:
To evaluate the effect of diabetic ketoacidosis (DKA) on the QT interval corrected for heart rate (QTc) in children. Ketosis occurs in several conditions, including DKA and alcoholic ketoacidosis, and during use of very low-carbohydrate diets. Prolongation of the QTc has been described in a few children receiving ketogenic diets, but cardiac effects of ketosis have not otherwise been investigated.
Design:
For this observational study, we performed electrocardiography during DKA and after recovery. We measured QTc as the QT interval divided by the square root of the R-R interval and correlated QTc with clinical variables.
Setting:
The pediatric emergency department and intensive care unit of an academic medical center.
Patients:
Thirty children with type 1 diabetes mellitus and DKA.
Main Outcome Measure:
The QTc during DKA.
Results:
The mean (SD) QTc during DKA was 450 (38) milliseconds (range, 378-539 milliseconds). After recovery from DKA, the mean (SD) QTc decreased to 407 (36) milliseconds (range, 302-485 milliseconds; difference, 43 milliseconds; 95% confidence interval, 23-63 milliseconds) (P < .001). Fourteen of the 30 children (47%) had prolonged QTc during DKA (range, 450-539 milliseconds). After recovery from DKA, only 4 children (13%) had persistent QTc prolongation (range, 451-485 milliseconds). The anion gap was significantly associated with QTc prolongation (correlation coefficient, 0.49; P = .006). Most patients had no electrolyte abnormalities or hypoglycemia to account for QTc prolongation.
Conclusions:
Prolonged QTc occurs frequently during DKA and is correlated with ketosis. Current guidelines regarding cardiac monitoring of children during DKA should be strictly followed, and electrocardiographic screening of patients with other ketotic conditions should be considered.
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