Sungeeta Agrawal1, Robin Kremsdorf2,3, Serife Uysal3,4, Meghan E Fredette3,4, Lisa Swartz Topor3,4. 1. Division of Pediatric Endocrinology, Floating Hospital for Children at Tufts Medical Center/ Tufts University School of Medicine, Boston, Massachusetts. 2. Division of Pediatric Nephrology, Rhode Island Hospital, Providence, Rhode Island. 3. The Warren Alpert Medical School of Brown University, Providence, Rhode Island. 4. Division of Pediatric Endocrinology, Hasbro Children's Hospital/Rhode Island Hospital, Providence, Rhode Island.
Abstract
OBJECTIVE: To determine the frequency of nephrolithiasis as a complication of diabetic ketoacidosis (DKA) in pediatrics. METHODS: We performed a retrospective chart review of patients with DKA admitted to a pediatric hospital between January 2009 and July 2016. We identified patients with nephrolithiasis during admission for DKA. RESULTS: We identified 395 episodes of DKA over 7.5 years. Nephrolithiasis developed as a complication of DKA in 3 of those admissions (0.8%). All three patients with nephrolithiasis were males with new onset type 1 diabetes, aged 11 to 16.5 years. They all developed symptoms of nephrolithiasis after transition to subcutaneous insulin. One patient had subsequent worsening acidosis that required an additional 24 hours of IV insulin administration. CONCLUSIONS: Nephrolithiasis is a rare complication of pediatric DKA, and should be considered in children with DKA who develop hematuria, flank pain, or suprapubic pain. Nephrolithiasis can increase insulin resistance due to increased pain and inflammation, so these patients should be monitored closely for recurrence of DKA. As patients with diabetes have increased risk of chronic kidney disease and nephrolithiasis can cause kidney injury, risk factors for nephrolithiasis should be identified and addressed to avoid subsequent kidney damage.
OBJECTIVE: To determine the frequency of nephrolithiasis as a complication of diabetic ketoacidosis (DKA) in pediatrics. METHODS: We performed a retrospective chart review of patients with DKA admitted to a pediatric hospital between January 2009 and July 2016. We identified patients with nephrolithiasis during admission for DKA. RESULTS: We identified 395 episodes of DKA over 7.5 years. Nephrolithiasis developed as a complication of DKA in 3 of those admissions (0.8%). All three patients with nephrolithiasis were males with new onset type 1 diabetes, aged 11 to 16.5 years. They all developed symptoms of nephrolithiasis after transition to subcutaneous insulin. One patient had subsequent worsening acidosis that required an additional 24 hours of IV insulin administration. CONCLUSIONS:Nephrolithiasis is a rare complication of pediatric DKA, and should be considered in children with DKA who develop hematuria, flank pain, or suprapubic pain. Nephrolithiasis can increase insulin resistance due to increased pain and inflammation, so these patients should be monitored closely for recurrence of DKA. As patients with diabetes have increased risk of chronic kidney disease and nephrolithiasis can cause kidney injury, risk factors for nephrolithiasis should be identified and addressed to avoid subsequent kidney damage.
Keywords:
DKA; International Society of Pediatric and Adolescent Diabetes; Pediatric Health Information System; acute kidney injury; diabetes; diabetes mellitus; electronic medical record; intravenous fluids; nephrolithiasis; new onset diabetes mellitus; pediatrics; research electronic data capture; type 1 diabetes mellitus
Authors: Sungeeta Agrawal; Serife Uysal; Meghan Fredette; Lisa Swartz Topor; Shara R Bialo; Michael Herzlinger; Jason Shapiro; Linda K Snelling; Charlotte M Boney; Jose Bernardo Quintos Journal: Case Rep Endocrinol Date: 2021-03-05