Hyperglycemic Emergencies in Children

Pillai, Mini G

doi:10.5005/jp/books/12092_9

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“…3 An episode of diabetic ketoacidosis has a mortality risk of 0.15%-0.3%. 4 Diabetic ketoacidosis is characterised by the biochemical triad of hyperglycaemia, ketonaemia (ketonuria) and acidaemia. It results from absolute or relative deficiency of circulating insulin and the effects of increased concentration of the counter-regulatory hormones.…”

Section: Introductionmentioning

confidence: 99%

Diabetic Ketoacidosis in Children- Clinical Profile and Outcome

Padma¹,

Antony²

2017

jebmh

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BACKGROUND Diabetic ketoacidosis is a potentially life-threatening condition, which accounts for the majority of diabetes-related morbidity and mortality in children with type 1 diabetes mellitus. Early diagnosis and prompt management substantially reduces the mortality. The aim of the study is to assess the clinical characteristics and early outcome in children with diabetic ketoacidosis. MATERIALS AND METHODS This is a descriptive study done in a tertiary care hospital. Fifty two episodes of diabetic ketoacidosis in children of age ≤12 years admitted during the period 2011 to 2016 were included in the study. Clinical details, investigations and complications were recorded in a pro forma and data was analysed using statistical tests. RESULTS Fifty two episodes of diabetic ketoacidosis were included in the study. Thirty three (63.5%) children presented with DKA at first diagnosis of diabetes, whereas 19 (36.5%) were DKA among children with established diabetes. Mean age at presentation was 9.048 ± 3.24. Female-to-male ratio was (1.36:1). The mean duration of onset of symptom before hospitalisation was 10.10 ± 9.52. Most commonly observed presenting symptoms were polyuria (63.46%), polydipsia (65.38%), tiredness (61.54%), vomiting (36.54%) and pain abdomen (32.69%). Mild DKA occurred frequently than moderate and severe forms. Among these children, 40.4% had infection as the predisposing factor. Demographic variables like age, gender, socioeconomic status, family history of diabetes did not have any significant association with the severity of DKA. The clinical parameters like tachypnoea, Kussmaul breathing, shock, altered sensorium at presentation and dehydration had significant association with the severity of DKA. Similarly, hypoglycaemia, hypokalaemia, hyponatraemia, acute kidney injury and cerebral oedema had significant association with the severity of DKA. All the patients recovered with therapy. No mortality was reported. CONCLUSION Diabetic ketoacidosis can be the initial presentation of diabetes mellitus or can occur in children with established diabetes mellitus. The mortality can be reduced by timely diagnosis and proper management. Diabetes education programs and follow up care of the patients should be strengthened to reduce the incidence of DKA.

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Section: Introductionmentioning

confidence: 99%