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Published on: June 11, 2012
Diabetic ketoacidosis in a pediatric intensive care unit
Clarice L S Lopes1, Paula Pitta Pinheiro1, Luzia S Barberena1
1Hospital da Criança Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil.
Insights
Children newly diagnosed with type 1 diabetes mellitus (T1DM) were younger and experienced more hypokalemia and longer hospital stays than those with a prior T1DM diagnosis. Severity on admission was similar between groups.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Critical Care Medicine
Background:
- Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus.
- Understanding DKA characteristics in children is crucial for effective management.
- Comparing outcomes between new-onset and previously diagnosed type 1 diabetes mellitus (T1DM) can inform clinical practice.
Purpose of the Study:
- To characterize children (0-14 years) with DKA.
- To compare outcomes in children with and without prior T1DM diagnosis, including hospital stay, severity, insulin use, fluid management, and complications.
Main Methods:
- Retrospective descriptive study of 52 pediatric intensive care unit admissions (June 2013 - July 2015).
- Analysis of patient demographics, clinical presentation, laboratory values, treatment parameters, and complications.
- Comparison of outcomes between children with and without a prior T1DM diagnosis.
Main Results:
- Patients without prior T1DM were younger (mean age 8.4 years) and presented with more nausea, vomiting, polydipsia, polyuria, and weight loss.
- Higher prevalence of hypokalemia and longer hospital stays were observed in the group without prior T1DM diagnosis.
- No significant differences in DKA severity on admission were found between the groups.
Conclusions:
- Children without a prior T1DM diagnosis at DKA onset are younger and experience more hypokalemia and prolonged hospital stays.
- DKA management requires careful electrolyte monitoring, especially in new-onset T1DM.
- Despite differences in presentation, DKA severity on admission was comparable, highlighting the acute nature of the condition in both groups.
Objective:
To describe the characteristics of children aged 0-14 years diagnosed with diabetic ketoacidosis and compare the following outcomes between children with prior diagnosis of type 1 diabetes mellitus and children without prior diagnosis of type 1 diabetes mellitus length of hospital stay, severity on admission, insulin dosage, time of continuous insulin use, volume of fluids infused during treatment, and complications.
Methods:
A retrospective descriptive study with review of medical records of patients admitted to the pediatric intensive care unit of a referral hospital from June 2013 to July 2015. The following data regarding 52 admissions were analyzed: age, sex, weight, body surface area, signs, symptoms and severity on admission, blood gas, blood glucose, glycated hemoglobin, serum osmolarity, and index of mortality. The insulin dosage, time of continuous insulin use, volume administered in the expansion phase and in the first 24h, length of stay, and complications such as electrolyte disturbances, hypoglycemia, cerebral edema, and death were compared between the two groups.
Results:
Patients without a previous diagnosis of DM1 were younger at admission, with mean age of 8.4 years (p<0.01), reported more nausea or vomiting, polydipsia and polyuria, and showed more weight loss (p<0.01). This study also observed a higher prevalence of hypokalemia (p<0.01) and longer hospital stay in this group.
Conclusions:
No differences in severity between groups were observed. The study showed that children without prior diagnosis of type 1 diabetes mellitus were younger at admission, had more hypokalemia during the course of treatment, and had greater length of hospital stay.
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