ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents

Dunger, David B.; Sperling, Mark A.; Acerini, Carlo L.; Bohn, Desmond; Daneman, Denis; Danne, Thomas; Glaser, Nicole; Hanås, Ragnar; Hintz, Raymond L.; Levitsky, Lynne L.; Savage, Martin O.; Tasker, Robert C.; Wolfsdorf, Joseph I.

doi:10.1136/adc.2003.044875

Cited by 274 publications

(242 citation statements)

References 105 publications

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“…Recently, the management of DKA in children has been reviewed by an international consensus group [29,30]. Our findings are largely compatible with the decisions of that group as to how risk of cerebral oedema could be avoided.…”

Section: Discussionsupporting

confidence: 82%

The UK case–control study of cerebral oedema complicating diabetic ketoacidosis in children

et al. 2006

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Aims/hypothesis Cerebral oedema complicating diabetic ketoacidosis (DKA) remains the major cause of morbidity and mortality in children with type 1 diabetes, but its aetiology remains unknown. Our objective was to determine the impact of baseline biochemical factors and of treatment-related variables on risk of the development of cerebral oedema in children with DKA. Materials and methods This was a national UK casecontrol study. Through the British Paediatric Surveillance Unit we identified 43 cases of cerebral oedema. Through a parallel reporting system, we also identified 2,940 episodes of DKA and selected 169 control subjects on the basis of comparable age, sex, numbers of new or known cases of diabetes and date of admission. Baseline biochemical data and treatment-related variables were extracted from the clinical notes of cases and control subjects. Results Allowing for differences in age, sex and new or known diabetes, cases were more acidotic at diagnosis of DKA (odds ratio [OR] for events in the least acidotic compared with the most acidotic tertile=0.02 [95% CI: 0.002-0.15], p<0.001). In addition, cases had higher potassium and urea levels at baseline. Calculated osmolality and baseline glucose were not significantly different. After allowing for severity of acidosis, insulin administration in the first hour .5], p=0.02) and volume of fluid administered over the first 4 h .97], p=0.01) were associated with risk. Low baseline plasma sodium and an elevated p a CO 2 also contributed to risk in the final regression model. Bicarbonate administration was not associated with increased risk of an event when corrected for acidosis. Conclusions/interpretation In this case-control study of DKA, baseline acidosis and abnormalities of sodium, potassium and urea concentrations were important predictors of risk of cerebral oedema. Additional risk factors identified were early administration of insulin and high volumes of fluid. These observations should be taken into account when designing treatment protocols.

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Section: Discussionsupporting

confidence: 82%

The UK case–control study of cerebral oedema complicating diabetic ketoacidosis in children

et al. 2006

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“…Zieve et al [22] described 124 patients, aged 14 -75 years, with moderate to severe DKA, nothing that the total WBC ranged from 4200 to 48,000. Cohen et al [23] found that the WBC count ranged from 5100 to 43,000 in patients with severe DKA. Our study showed a range of 8100 to 51,000.…”

Section: Discussionmentioning

confidence: 99%

“…Our study showed a range of 8100 to 51,000. The origin of the leukocytosis observed in adult patients with DKA is unknown but has been attributed, in part, to increased catecholamine release from the adrenal gland in response to stress; marked dehydration and resulting hemoconcentration may also play a role [23][24]. On the other hand, kayashima et al [25] found that granulocyte colonystimulating factor does not appear to be a mediator in this response.…”

Section: Discussionmentioning

confidence: 99%

“…Perhaps these same limitations in retrospectively identifying infections account for the wide range of infections rates as described in adults with DKA in previously published studies. For instance, Cohen et al [23] stated that infection, either major or minor, is listed as the cause of DKA in 15% to 50% of the cases. Our findings of 47.7% (n = 461) infection rate is within the wide range reported.…”

Section: Discussionmentioning

confidence: 99%

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Prediction and rate of infections in diabetes mellitus patients with diabetes ketoacidosis in Penang, Malaysia

Gillani¹,

Sulaiman²,

Sundram³

2012

OJEpi

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Study aimed to determine the rate and prediction of infection in diabetes mellitus patients ≥ 18 year, with diabetic ketoacidosis (DKA). Retrospective cohort study design was adopted to achieve the objectives. Universal sampling technique was employed for data collection among Diabetes ketoacidosis patients, over a period of 3 years (Jan 2008-Dec 2010). Statistical package for social sciences used to analyze data. Over a 3-year period, total of 967 admissions were identified. Of it, 112 (11.6%) with no infection, 679 (70.2%) with bacterial infection and 176 (18.2%) with presumed viral infection. The mean WBC for all the patients was 18,177 (±9431). 721 (74.6%) had leukocytosis, as defined by a WBC ≥ 15,000/mm 3 . WBC, differential, leukocytosis, as well as sex, temperature were not significant predictors (p > 0.05) of bacterial infection. There was significant (p < 0.05) difference of age between the 3 groups, age above 57 years have high rate of infection as compared to age below and equal 57 years. The infection rate in elderly patients with DKA was high and majority of them had lack of clinical evidence. Major bacterial infections with potential serious sequel were particularly common (33.3%), among every third patient being presumed to have serious consequences.

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“…1 DKA is commonly associated with type 1 diabetes and poses a significant threat at the time of diagnosis. 2,3 Amidst growing concerns about the rising burden of type 1 diabetes, incidence trends predict a doubling of newly diagnosed cases in Europe by 2020. 4 However, the incidence of DKA at diagnosis of type 1 diabetes in the UK has remained unchanged at around 25% over the past 20 years.…”

Section: Introductionmentioning

confidence: 99%

Management of diabetic ketoacidosis following implementation of the JBDS guidelines: Where are we and where should we go?

et al. 2015

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ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents

Cited by 274 publications

References 105 publications

The UK case–control study of cerebral oedema complicating diabetic ketoacidosis in children

The UK case–control study of cerebral oedema complicating diabetic ketoacidosis in children

Prediction and rate of infections in diabetes mellitus patients with diabetes ketoacidosis in Penang, Malaysia

Management of diabetic ketoacidosis following implementation of the JBDS guidelines: Where are we and where should we go?

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