A Nested Case-Control Study of Adverse Outcomes in Children With Diabetic Ketoacidosis
Maha F Yousif1, Katie D Dolak1, Soumya Adhikari1
1Division of Pediatric Endocrinology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX 75390-9063, USA.
The Journal of Clinical Endocrinology and Metabolism
|December 10, 2024
Summary
Children with diabetic ketoacidosis (DKA) or hyperglycemic-hyperosmolar syndrome (HHS) experiencing adverse outcomes often present with hypernatremia. This condition, present on admission and persisting during treatment, is linked to poorer outcomes, not management differences.
Area of Science:
- Pediatric Endocrinology
- Critical Care Medicine
- Metabolic Disorders
Background:
- Adverse Outcomes in pediatric diabetic ketoacidosis (DKA) and hyperglycemic-hyperosmolar syndrome (HHS) are predictable by a composite risk score.
- Most high-risk patients do not experience adverse outcomes, necessitating identification of other influencing factors.
Purpose of the Study:
- To identify clinical characteristics and management differences associated with adverse outcomes in pediatric DKA-HHS.
- To investigate factors beyond the composite risk score that impact patient outcomes.
Main Methods:
- A nested case-control study was conducted on 4565 admissions for DKA-HHS (2010-2023).
- 84 cases with adverse outcomes were matched with 84 controls based on a composite risk score.
- Analysis focused on initial clinical data and treatment course differences.
Main Results:
- Cases with adverse outcomes showed higher initial serum sodium and BUN, and more new-onset diabetes.
- Hyperglycemia, acidosis, and hypernatremia resolved slower in the case group.
- No significant differences were found in fluid administration or initial insulin doses, but cases required IV insulin longer.
Conclusions:
- Persistent hypernatremia at admission and during the first 24 hours of treatment is a key indicator of adverse outcomes in pediatric DKA-HHS.
- These adverse outcomes are not explained by differences in clinical management strategies.
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