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Frequency of complications of DKA in children admitted in PICU

Meisam Sharifzadeh1, Masoud Mohammadpour1, Bahareh Yaghmaee1

  • 1Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran.

BMC Pediatrics
|June 9, 2026
PubMed

Insights

Diabetic ketoacidosis (DKA) complications like electrolyte imbalances and cerebral injury are common in children admitted to the pediatric intensive care unit (PICU). Severe DKA and hypernatremia increase the risk of cerebral injury, necessitating careful management.

Area of Science:

  • Pediatric Endocrinology
  • Critical Care Medicine
  • Diabetology

Background:

  • Diabetic ketoacidosis (DKA) is a severe complication of diabetes in children, often requiring pediatric intensive care unit (PICU) admission.
  • Treatment and management of DKA in children are complex and associated with significant uncertainty.
  • Understanding DKA-related complications is vital for improving clinical outcomes in pediatric patients.

Purpose of the Study:

  • To determine the frequency and severity of DKA in pediatric PICU admissions.
  • To identify common electrolyte abnormalities associated with DKA.
  • To evaluate the link between DKA severity, electrolyte disturbances, and the risk of cerebral injury and other acute complications.

Main Methods:

  • A cross-sectional retrospective study of pediatric patients (1 month–16 years) admitted with DKA to a tertiary referral center's PICU.
  • Data collected included demographics, laboratory findings, and clinical outcomes based on ISPAD criteria.
  • Evaluated frequency of complications such as electrolyte disturbances, cerebral injury, and acute kidney injury (AKI).

Main Results:

  • 161 pediatric patients with DKA were analyzed; mean age was 8.22 years.
  • Common electrolyte abnormalities included hypophosphatemia (60.9%), hypokalemia (50.9%), and hyponatremia (46.6%).
  • Cerebral injury occurred in 8.1% and AKI in 3.7%; severe DKA and hypernatremia were linked to increased cerebral injury risk.

Conclusions:

  • Electrolyte disturbances and cerebral injury are frequent complications in pediatric DKA patients admitted to the PICU.
  • Severe DKA and hypernatremia are significant risk factors for cerebral injury in this population.
  • Prompt recognition and meticulous management of DKA complications are essential for optimizing pediatric patient outcomes.
Abstract

Keywords:
Cerebral edemaDiabetic ketoacidosisElectrolyte disturbancesPediatric intensive care unit

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