Cumhuriyet Medical Journal

Abstract

Objective: Diabetic ketoacidosis (DKA) is the main cause of morbidity and mortality in
children with type-I Diabetes Mellitus. The goals of therapy are to
correct dehydration, resolution of acidosis and fading of ketosis. Such serious
complications necessitate closed monitoring of DKA patients with delicate,
balanced therapy, probably at an intensive care facility.

Regarding
the fact that, each facility shoul determine the clinical
profile of their own patient population, we aimed to investigate the
risk factors for consequences and determine the timing of DKA resolution by
analyzing the demographic and epidemiologic data, clinical outcome and the
prognosis of diabetic ketoacidotic children admitted to PICU. 

Method: This descriptive, retrospective study was
conducted in 105 children admitted to PICU with the complaints of DKA between
January 2014 and December 2108. Demograhic data including age, gender, weight,
height, body mass index (BMI), initial compliants with clinical findings and
level of consciousness
were recorded. Children were categorized into two
groups depending on the timing of DM diagnosis (new onset of diabetes and
established diabetes mellitus). DKA severity was determined by the degree of
metabolic acidosis (mild, moderate, severe).  

SPSS-23 was used
for statictics. Descriptive analyses were expressed as percentages,
mean±standart deviation (SD), median with minimum and maximum values. Chi
square and Fischer exact test were used for comparison of categorical
variables. Student’s t-test, Mann Whitney U test and Wilcoxon rank sum test
were assessed for continous variables. Pearson correlation coefficient and
logistic regressions were used for correlations and to determine the risk
factors. P-value < 0.05 was considered significant.

Results: The patient demographics presented the
mean age as 11.31±4.18 years, female/male ratio 1/1.4 and body mass index
18.48±4.48. Children were classified as mild DKA (29.5%), moderate DKA (35.2%)
and severe DKA (35.2%) based on the acidosis severity. 48.6% of the patients
had Kusmaull respiration; 30.5% had manifested altered consciousness. One
patient had tomography-proven brain edema and had required mechanical
ventilation due to neurological incapability to sustain airway

Children
with new onset of diabetes accounted for 51.4% of the study population. The
mean age was 9.70±4.47 years; this group constituted a younger population
compared the established DM patients (p<0.001). Altered mental state and
kusmaull respiration also occurred at a higher rate and the major complaint
seemed ae weight loss within two weeks (p=0.006, p=0.002, p<0.001
respectively).

Children with established diabetes
mellitus presented significant biochemical abnormalities in terms of elevated
BUN and serum potassium levels (p<0.001, p<0.001); infections occurred as
the major triggering factor for DKA at a rate of 80.4% at this group. 

We observed a positive correlation
with DKA resolution with serum creatinine, calculated osmolality, anion gap
(r=0.242, r=0.215, r=0.302) and a negative correlation with blood gas pH and
HCO3 (r= -0.704, r= -0.694). In the multivariable regression model including
age, gender, body mass index, PRISM-3 score, BUN, serum potassium, phosphate
and chloride, only blood gas pH and new onset of diabetes appeared to be the
independent risk factors for DKA resolution. 0.1 unit decrement in blood gas pH
elongated the resolution by 3.76 hours (p<0.001, adjusted ratio: 0.743). New
onset of diabetes mellitus also increased the length of resolution by 5.30
hours (p<0.001).

Conclusions:
Inıtial
blood gas pH and presence of new onset of diabetes are the major risk factors
in resolution of ketoacidosis.