A Retrospective Analysis of Children and Adolescents With Diabetic Ketoacidosis in the Intensive Care Unıt: Is It Significant that the Blood Ketone Level Becomes Negative in Diabetic Ketoacidosis?

Abstract

Introduction: Diabetic ketoacidosis (DKA) is the most common cause of acute morbidity and mortality in children and adolescents with type 1 diabetes mellitus (T1DM). Because DKA management is associated with complications, endocrine communities have published guidelines and attempted to set standards for DKA diagnosis and management worldwide. In this study, for the patients followed up in the intensive care unit who have been treated according to DKA protocols, clinical and laboratory characteristics, differences between new and old diagnosed patients, and results of treatment were evaluated. Methods: The records of 67 patients hospitalized in the pediatric intensive care unit for the past two years were reviewed retrospectively. Patients were grouped as newly diagnosed and old diagnosed diabetics. Results: The mean age of the patients was 8.66 ± 5.0 years (3 months to 17.9 years) and 39 (58.2%) were male. Forty-five patients (67.1%) presented with mild DKA and 22 (33.9%) with severe DKA. Fourteen (63.6%) of the severe DKA cases were newly diagnosed with T1DM. Six patients had hyponatremia (corrected serum Na level <135 mmol/L) and five had hypernatremia (serum Na level >145 mmol/L). Only one of the hyponatremic patients had severe acidosis, while four of the hypernatremic patients had severe acidosis. At the 14th hour, blood glucose levels were below 200 mg/dl, blood ketones became negative in 5.8 hours, and at 9.1 hours, blood pH and/or HCO 3 levels were normalized, recovery criteria were completed, and subcutaneous (SC) insulin injection was started. Of the patients, 38 (56.7) were newly diagnosed with T1DM. The mean age of newly diagnosed T1DM patients was smaller (7.40 ± 4.96) than those with old diagnosis, respiratory rates (RRs) were higher and pCO 2 levels were lower on admission. Blood glucose, blood ketone negativity, acidosis, and Glasgow coma score (GCS) scores of the newly diagnosed T1DM patients improved later than the previous diagnoses. Only one patient under two years of age with a pH of 6.89 was given HCO 3. None of the patients had symptomatic brain edema and death. Conclusions: As a result, DKA is an acute and serious complication of diabetes, whose results are promising when managed only with minimal individual changes according to guidelines. Bicarbonate administration is not needed except in patients with very severe acidosis. Bedside blood ketone monitoring seems to be important because it allows for early enteral feeding.

Relationship Between Bedside Ketone Levels and Time to Resolution of Diabetic Ketoacidosis: A Retrospective Cohort Study

“…While our study design did not provide an answer to this important question, it is noteworthy that the reported time required to secure DKA resolution varied widely from one study to another. We limited our literature search to studies that defined DKA resolution as a fall in 3HB [13,[20][21][22][23][26][27][28]. On the basis of these studies, it seems that the 3HB level on admission could be a significant predictor of the time to DKA resolution.…”

“…In this regard, bedside 3HB has been reported to correlate well with blood pH levels [12][13][14][15][16], as well as with plasma ketone [17][18][19]. On the basis of this, a number of studies investigated the usefulness of bedside ketone body monitoring to the response to treatment of DKA [13,17,[20][21][22][23].…”

Treatment Outcome and Associated Factors among Type 1 Diabetic Children&lt;15 Years Admitted With DKA in Bahir Dar City Public Referral Hospital, North West, Ethiopia: A retrospective Cross Sectional Study

“…(17).The inclusive proportion of children diagnosed with DKA in Addis Ababa Ethiopia was high(35.8%) (18).Likewise in Gojjam Ethiopia the overall incidence rate of DKA was 2.27 per 100 children/month of observation (19). DKA is the most common cause of acute comorbidity and mortality in children with T1DM with the range of 16.5 to 78% admission rate in hospital (15).With the average length of recovery time between 24hours-8 days (8,10).where a low pH and high total leucocyte count (TLC) at admission were observed to be associated with prolonged acidosis (21).The pooled mortality rate for DKA is estimated to range from 2-5% in developed nations and 6-24 % in developing countries (22), (23).…”

“…The DKA management protocol which can be used in pediatrics clinical care unit was prepared by the pediatric endocrine and diabetes associations in 2016 based on the international society for pediatric and adolescent diabetic (ISPAD) and European society for pediatric endocrinology (ESPE) guidelines ( 12), (15). DKA management is too challenging as it can be associated with different types complication.…”

Time to First Optimal Glycemic Control and its Predictors Among Type 1 Diabetic Children&lt;15 Years in Bahir Dar City Public Referral Hospitals, North West Ethiopia: A Retrospective Follow Up Study

“…Many are not detected and those diagnosed have dramatically reduced their life expectancy by one year, (17)(18)(19). Poor glycemic control was much higher among type one patients(82.9%) as compared with type two diabetics(57.7%) (14,20,21).…”