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Clinical profile of diabetic ketoacidosis in Indian children
Sandeep Kumar Kanwal1, Ajay Bando, Virendra Kumar
1Division of PICU and Emergency, Department of Pediatrics, Kalawati Saran Children's Hospital, New Delhi, India. drskumar811@rediffmail.com
Insights
Diabetic ketoacidosis (DKA) in Indian children often presents as newly diagnosed diabetes, with severe symptoms like dehydration and altered sensorium. Complications such as cerebral edema and sepsis contribute to adverse outcomes in pediatric DKA cases.
Area of Science:
- Pediatric Endocrinology
- Critical Care Medicine
- Metabolic Disorders
Background:
- Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus.
- Understanding the clinical profile of DKA in Indian children is crucial for timely diagnosis and management.
- Previous studies have highlighted varying DKA prevalence and outcomes globally.
Purpose of the Study:
- To investigate the clinical characteristics of Indian children admitted with DKA.
- To identify common presenting symptoms, laboratory findings, and complications in this population.
- To determine factors associated with adverse outcomes in pediatric DKA.
Main Methods:
- A retrospective descriptive study was conducted in a pediatric ICU in Delhi.
- Case records of 55 children admitted with DKA between January 2008 and January 2010 were reviewed.
- Data on demographics, clinical features, laboratory parameters, management, and outcomes were collected and analyzed.
Main Results:
- The mean age of presentation was 7.4 years, with equal gender distribution.
- Over half of the cases (56.4%) were newly diagnosed diabetes.
- Common symptoms included polyuria, polydipsia, vomiting, altered sensorium, and abdominal pain; severe dehydration was frequent. Notable complications included hypernatremia (20%), hypokalemia (14.5%), cerebral edema (14.5%), and renal failure (7.2%).
Conclusions:
- DKA affects Indian boys and girls equally, with over 50% of admissions being new diabetes cases.
- A significant proportion (nearly two-thirds) presented with severe DKA.
- Renal failure, cerebral edema, and sepsis were key contributors to mortality.
Objective:
To study the clinical profile of the Indian children admitted with DKA.
Methods:
This descriptive retrospective study was conducted in pediatric ICU of tertiary level care hospital at Delhi (between Jan 2008 and Jan 2010). The case records of 55 children admitted with DKA were reviewed and information with respect to the personal details, clinical features, laboratory parameters, management and outcome was recorded using a predesigned performa.The data was analyzed using SPSS version 16.
Results:
The mean age of patients at presentation was 7.4±3.9 y; 27 boys and 28 girls were enrolled. Diabetes was newly diagnosed in 56.4% patients and 43.6% were known cases of diabetes. Polyuria and polydipsia (54.5%), persistent vomiting (52.7%), altered sensorium (50.9%), abdominal pains (47.3%) were common presenting symptoms. Most of the children had dehydration at admission, one fourth being severe. Hypernatremia, hypokalemia, cerebral edema and renal failure were observed in 20%, 14.5%, 14.5% and 7.2% , respectively. While 12.72% had fatal outcome, cerebral edema with or without renal failure and sepsis accounted for most of the deaths.
Conclusions:
Boys and girls were equally affected. Newly diagnosed diabetics constituted more >50% of total DKA admissions. Nearly two third presented with severe DKA. Renal failure, cerebral edema and sepsis contributed to adverse outcome.
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