M Jayashree1, Sunit Singhi. 1. Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Abstract
OBJECTIVES: To study the outcome and predictors of mortality in children with diabetic ketoacidosis. DESIGN: Retrospective case series. SETTING: Pediatric intensive care unit of an urban multiple-specialty teaching and referral hospital in north India. PATIENTS: Sixty-eight patients with diabetic ketoacidosis treated between 1993 and 2000. INTERVENTIONS: Data were retrieved from case records with respect to patients' age; clinical features; osmolality at admission; blood glucose, serum potassium, and arterial pH at admission, 6 hrs, and 24 hrs; complications during the course of hospital stay; treatment; and outcome in terms of survival or death. Survivors and nonsurvivors were compared to determine the predictors of mortality. MEASUREMENTS AND MAIN RESULTS: The mean (sd) age of the study population was 6.9 (3.5) yrs (range, 0.5-12 yrs). Impaired consciousness (n = 45; 66%), rapid breathing (n = 41; 60%), and vomiting (n = 35; 51.4%) were common presenting symptoms. Thirty-two (50%) patients had clinically evident dehydration. Precipitating events identified were new-onset diabetes with sepsis (37%), new-onset diabetes alone (31%), insulin omission (15%), and infection with insulin omission (7%). The mean (sd) blood glucose, osmolality, and pH at admission were 473 (sd 184) mg/dL, 305 (sd 24) mOsm/L, and 7.08 (sd 0.1), respectively. Complications noted during treatment were hypokalemia (n = 28; 41%), hypoglycemia (n = 10; 15%), cerebral edema (n = 9; 13.2%), and pulmonary edema (n = 2; 3%). Nine (13.2%) patient died, with the causes of death being septic shock (n = 4), cerebral edema (n = 2), cerebral edema with pulmonary edema (n = 2), and hypokalemia with ventricular tachycardia (n = 1). Those who died were older, had higher osmolality and severe acidosis at admission, and had persistent hyperglycemia and acidosis at 6-12 hrs. On multiple logistic regression analysis, osmolality at admission was the most significant predictor of death. CONCLUSIONS: Two thirds of children with diabetic ketoacidosis in our series had new-onset diabetes, and 13.2% died. Serum osmolality at admission was the most important predictor of death.
OBJECTIVES: To study the outcome and predictors of mortality in children with diabetic ketoacidosis. DESIGN: Retrospective case series. SETTING: Pediatric intensive care unit of an urban multiple-specialty teaching and referral hospital in north India. PATIENTS: Sixty-eight patients with diabetic ketoacidosis treated between 1993 and 2000. INTERVENTIONS: Data were retrieved from case records with respect to patients' age; clinical features; osmolality at admission; blood glucose, serum potassium, and arterial pH at admission, 6 hrs, and 24 hrs; complications during the course of hospital stay; treatment; and outcome in terms of survival or death. Survivors and nonsurvivors were compared to determine the predictors of mortality. MEASUREMENTS AND MAIN RESULTS: The mean (sd) age of the study population was 6.9 (3.5) yrs (range, 0.5-12 yrs). Impaired consciousness (n = 45; 66%), rapid breathing (n = 41; 60%), and vomiting (n = 35; 51.4%) were common presenting symptoms. Thirty-two (50%) patients had clinically evident dehydration. Precipitating events identified were new-onset diabetes with sepsis (37%), new-onset diabetes alone (31%), insulin omission (15%), and infection with insulin omission (7%). The mean (sd) blood glucose, osmolality, and pH at admission were 473 (sd 184) mg/dL, 305 (sd 24) mOsm/L, and 7.08 (sd 0.1), respectively. Complications noted during treatment were hypokalemia (n = 28; 41%), hypoglycemia (n = 10; 15%), cerebral edema (n = 9; 13.2%), and pulmonary edema (n = 2; 3%). Nine (13.2%) patient died, with the causes of death being septic shock (n = 4), cerebral edema (n = 2), cerebral edema with pulmonary edema (n = 2), and hypokalemia with ventricular tachycardia (n = 1). Those who died were older, had higher osmolality and severe acidosis at admission, and had persistent hyperglycemia and acidosis at 6-12 hrs. On multiple logistic regression analysis, osmolality at admission was the most significant predictor of death. CONCLUSIONS: Two thirds of children with diabetic ketoacidosis in our series had new-onset diabetes, and 13.2% died. Serum osmolality at admission was the most important predictor of death.
Authors: Anil Regmi; Nikifor K Konstantinov; Emmanuel I Agaba; Mark Rohrscheib; Richard I Dorin; Antonios H Tzamaloukas Journal: Clin Diabetes Date: 2014-01
Authors: Nikifor K Konstantinov; Mark Rohrscheib; Emmanuel I Agaba; Richard I Dorin; Glen H Murata; Antonios H Tzamaloukas Journal: World J Diabetes Date: 2015-07-25
Authors: Elizabeth T Jensen; Dana A Dabelea; Pradeep A Praveen; Anandakumar Amutha; Christine W Hockett; Scott P Isom; Toan C Ong; Viswanathan Mohan; Ralph D'Agostino; Michael G Kahn; Richard F Hamman; Paul Wadwa; Lawrence Dolan; Jean M Lawrence; S V Madhu; Reshmi Chhokar; Komal Goel; Nikhil Tandon; Elizabeth Mayer-Davis Journal: Pediatr Diabetes Date: 2020-04-06 Impact factor: 3.409