J Korean Diabetes.  2017 Sep;18(3):193-204. 10.4093/jkd.2017.18.3.193.

Clinical and Laboratory Characteristics of Pediatric Diabetic Ketoacidosis: A Single-Center Study

Affiliations
  • 1Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea. children@jbnu.ac.kr
  • 2Research Institute of Clinical Medicine of Chonbuk National University–Biomedical Institute of Chonbuk National University Hospital, Jeonju, Korea.

Abstract

BACKGROUND
Diabetic ketoacidosis (DKA) is an acute complication of pediatric type 1 diabetes mellitus (T1DM). We aimed to determine the risk factors and clinical characteristics of children and adolescents with DKA.
METHODS
We retrospectively evaluated 59 episodes of DKA in 43 patients who were hospitalized for DKA between January 2006 and December 2015. DKA was classified as mild, moderate, or severe, according to patient history of DKA. The clinical and laboratory characteristics of these subgroups were compared.
RESULTS
The average patient age was 11.98 ± 4.40 years (range, 1.3~17.9 years). Moderate episodes were the most common, with 21 episodes (35.6%), followed by 19 severe (32.2%) and 19 mild episodes (32.2%). Significant differences were observed between the subgroups regarding their characteristics of aggravated. Severe DKA episodes were more often observed during the winter season. Recurrent DKA cases were determined in 31 episodes (52.5%) who were significantly older, had higher body mass index, and lower serum C-peptide levels than the newly diagnosed DKA group. Female patients experienced severe and moderate cases more frequently (P = 0.041), which included two deaths. Only blood glucose levels were significantly higher in these fatal cases (P = 0.022).
CONCLUSION
Even among the patients who had previously experienced DKA and older children with low serum C-peptide levels, there was no reduction in the severity of DKA. We recommend that patients with DKA be carefully treated and continuously informed regarding the importance of maintaining proper blood glucose levels, regardless of their previous history of DKA, age, or regularity of insulin therapy.

Keyword

Child; Diabetic ketoacidosis; Diabetes mellitus; Type 1

MeSH Terms

Adolescent
Blood Glucose
Body Mass Index
C-Peptide
Child
Diabetes Mellitus
Diabetes Mellitus, Type 1
Diabetic Ketoacidosis*
Female
Humans
Insulin
Retrospective Studies
Risk Factors
Seasons
Blood Glucose
C-Peptide
Insulin

Figure

  • Fig. 1. Seasonal distribution of diabetic ketoacidosis severity (A) and prior diabetic ketoacidosis history (B) on the day of admission. Months are numbered from 1∼12 for January∼December, respectively. DKA, diabetic ketoacidosis.


Reference

References

1. Lee JI, Sohn TS, Chang SA, Lee JM, Cha BY, Son HY, Son HS. Clinical characteristics and outcomes of diabetic ketoacidosis at a single institution. Korean Diabetes J. 2008; 32:165–70.
Article
2. Rewers A, Klingensmith G, Davis C, Petitti DB, Pihoker C, Rodriguez B, Schwartz ID, Imperatore G, Williams D, Dolan LM, Dabelea D. Presence of diabetic ketoacidosis at diagnosis of diabetes mellitus in youth: the Search for Diabetes in Youth Study. Pediatrics. 2008; 121:e1258–66.
Article
3. Rosenbloom AL. Hyperglycemic crises and their complications in children. J Pediatr Endocrinol Metab. 2007; 20:5–18.
Article
4. Kim MK, Lee SH, Kim JH, Lee JI, Kim JH, Jang EH, Yoon KH, Lee KW, Song KH. Clinical characteristics of Korean patients with new-onset diabetes presenting with diabetic ketoacidosis. Diabetes Res Clin Pract. 2009; 85:e8–11.
Article
5. Solá E, Garzón S, García-Torres S, Cubells P, Morillas C, HernándezMijares A. Management of diabetic ketoacidosis in a teaching hospital. Acta Diabetol. 2006; 43:127–30.
Article
6. Delaney MF, Zisman A, Kettyle WM. Diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome. Endocrinol Metab Clin North Am. 2000; 29:683–705. V.
Article
7. Barski L, Nevzorov R, Rabaev E, Jotkowitz A, Harman-Boehm I, Zektser M, Zeller L, Shleyfer E, Almog Y. Diabetic ketoacidosis: clinical characteristics, precipitating factors and outcomes of care. Isr Med Assoc J. 2012; 14:299–303.
8. Efstathiou SP, Tsiakou AG, Tsioulos DI, Zacharos ID, Mitromaras AG, Mastorantonakis SE, Panagiotou TN, Mountokalakis TD. A mortality prediction model in diabetic ketoacidosis. Clin Endocrinol (Oxf). 2002; 57:595–601.
Article
9. Freire AX, Umpierrez GE, Afessa B, Latif KA, Bridges L, Kitabchi AE. Predictors of intensive care unit and hospital length of stay in diabetic ketoacidosis. J Crit Care. 2002; 17:207–11.
Article
10. Wolfsdorf JI, Allgrove J, Craig ME, Edge J, Glaser N, Jain V, Lee WW, Mungai LN, Rosenbloom AL, Sperling MA, Hanas R. International Society for Pediatric and Adolescent Diabetes. ISPAD Clinical Practice Consensus Guidelines 2014. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2014; 15(Suppl 20):154–79.
11. Dunger DB, Sperling MA, Acerini CL, Bohn DJ, Daneman D, Danne TP, Glaser NS, Hanas R, Hintz RL, Levitsky LL, Savage MO, Tasker RC, Wolfsdorf JI; ESPE. LWPES. ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents. Arch Dis Child. 2004; 89:188–94.
Article
12. DIAMOND Project Group. Incidence and trends of childhood Type 1 diabetes worldwide 1990–1999. Diabet Med. 2006; 23:857–66.
13. EURODIAB ACE Study Group. Variation and trends in incidence of childhood diabetes in Europe. Lancet. 2000; 355:873–6.
14. Usher-Smith JA, Thompson MJ, Sharp SJ, Walter FM. Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review. BMJ. 2011; 343:d4092.
Article
15. Kim MS, Yu KY, Na JI, Kim JD, Lee OK, Lee DY. The changes of incidence of childhood diabetes in Jeollabuk-do for 26 years. J Korean Soc Pediatr Endocrinol. 2008; 13:29–35.
16. Dunger DB, Sperling MA, Acerini CL, Bohn DJ, Daneman D, Danne TP, Glaser NS, Hanas R, Hintz RL, Levitsky LL, Savage MO, Tasker RC, Wolfsdorf JI. European Society for Paediatric Endocrinology; Lawson Wilkins Pediatric Endocrine Society. European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society consensus statement on diabetic ketoacidosis in children and adolescents. Pediatrics. 2004; 113:e133–40.
Article
17. Fernandez Castañer M, Montaña E, Camps I, Biarnes J, Merino JF, Escriba JM, Nacher V, Rosel P, Soler J. Ketoacidosis at diagnosis is predictive of lower residual beta-cell function and poor metabolic control in type 1 diabetes. Diabetes Metab. 1996; 22:349–55.
18. Lee HJ, Yu HW, Jung HW, Lee YA, Kim JH, Chung HR, Yoo J, Kim E, Yu J, Shin CH, Yang SW, Lee SY. Factors associated with the presence and severity of diabetic ketoacidosis at diagnosis of type 1 diabetes in Korean children and adolescents. J Korean Med Sci. 2017; 32:303–9.
Article
19. Barski L, Harman-Boehm I, Nevzorov R, Rabaev E, Zektser M, Jotkowitz AB, Zeller L, Shleyfer E, Almog Y. Gender-related differences in clinical characteristics and outcomes in patients with diabetic ketoacidosis. Gend Med. 2011; 8:372–7.
Article
20. Oyarzabal Irigoyen M, García Cuartero B, Barrio Castellanos R, Torres Lacruz M, Gómez Gila AL, González Casado I, Hermoso López F, Luzuriaga Tomás C, Rica Etxebarrial I, López García MJ, Rodríguez Rigual M. Ketoacidosis at onset of type 1 diabetes mellitus in pediatric age in Spain and review of the literature. Pediatr Endocrinol Rev. 2012; 9:669–71.
21. Kalliora MI, Vazeou A, Delis D, Bozas E, Thymelli I, Bartsocas CS. Seasonal variation of type 1 diabetes mellitus diagnosis in Greek children. Hormones (Athens). 2011; 10:67–71.
Article
22. Demirbilek H, Özbek MN, Baran RT. Incidence of type 1 diabetes mellitus in Turkish children from the southeastern region of the country: a regional report. J Clin Res Pediatr Endocrinol. 2013; 5:98–103.
23. Krikovszky D, Luczay A, Körner A, Madácsy L. Diabetic ketoacidosis in childhood. Orv Hetil. 2000; 141:173–7.
24. Son KR, Kim JS, Lee HY, Noh HY, Back HJ, Woo YJ. Multifocal brain infarction and intraventricular hemorrhage in an infant during treatment of diabetic ketoacidosis. J Korean Soc Pediatr Endocrinol. 2002; 7:225–9.
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