Hypertension during Diabetic Ketoacidosis in Children
Andrew DePiero1, Nathan Kuppermann2, Kathleen M Brown3
1Division of Emergency Medicine, Department of Pediatrics, Nemours/A.I. DuPont Hospital for Children, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
Insights
Hypertension affects nearly 30% of children with diabetic ketoacidosis (DKA), even with dehydration. Factors like severe acidosis and low Glasgow Coma Scale scores are linked to its development during DKA treatment.
Area of Science:
- Pediatric Endocrinology
- Critical Care Medicine
- Nephrology
Background:
- Diabetic ketoacidosis (DKA) is a serious complication of diabetes in children.
- Hemodynamic alterations, including hypertension, can occur during DKA.
- Understanding factors associated with hypertension in DKA is crucial for management.
Purpose of the Study:
- To characterize hemodynamic changes during DKA in a large pediatric cohort.
- To identify clinical and biochemical factors associated with hypertension in children with DKA.
Main Methods:
- Secondary analysis of data from a randomized clinical trial on DKA fluid resuscitation.
- Assessment of hemodynamic data (heart rate, blood pressure) in children with DKA.
- Multivariable statistical modeling to identify predictors of hypertension.
Main Results:
- Hypertension occurred in 27.8% of 1258 DKA episodes.
- Factors associated with hypertension at presentation included severe acidosis (low pH, low pCO2) and acute kidney injury.
- Severe acidosis and lower Glasgow Coma Scale scores were associated with hypertension during DKA treatment.
Conclusions:
- Hypertension is common in children with DKA, despite dehydration.
- Severe acidosis and neurological status (Glasgow Coma Scale) are linked to hypertension during DKA.
- Findings suggest a potential central mediation of hypertension in DKA.
Objectives:
To characterize hemodynamic alterations occurring during diabetic ketoacidosis (DKA) in a large cohort of children and to identify clinical and biochemical factors associated with hypertension.
Study Design:
This was a planned secondary analysis of data from the Pediatric Emergency Care Applied Research Network Fluid Therapies Under Investigation in DKA Study, a randomized clinical trial of fluid resuscitation protocols for children in DKA. Hemodynamic data (heart rate, blood pressure) from children with DKA were assessed in comparison with normal values for age and sex. Multivariable statistical modeling was used to explore clinical and laboratory predictors of hypertension.
Results:
Among 1258 DKA episodes, hypertension was documented at presentation in 154 (12.2%) and developed during DKA treatment in an additional 196 (15.6%), resulting in a total of 350 DKA episodes (27.8%) in which hypertension occurred at some time. Factors associated with hypertension at presentation included more severe acidosis, (lower pH and lower pCO2), and stage 2 or 3 acute kidney injury. More severe acidosis and lower Glasgow Coma Scale scores were associated with hypertension occurring at any time during DKA treatment.
Conclusions:
Despite dehydration, hypertension occurs in a substantial number of children with DKA. Factors associated with hypertension include greater severity of acidosis, lower pCO2, and lower Glasgow Coma Scale scores during DKA treatment, suggesting that hypertension might be centrally mediated.
Related Concept Videos
01:15Diabetes: Symptoms, Diagnosis, and Complications
01:15Hypoglycemia and Glucagon
01:22Diabetes Mellitus: Type 2 and Gestational
01:20Pathophysiology of Diabetes
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility,...
01:22Diabetes Mellitus: Overview and Type I Subtype
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
01:36Carbohydrate Metabolism
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in...