Nephrolithiasis: A complication of pediatric diabetic ketoacidosis

Agrawal, Sungeeta; Kremsdorf, Robin; Uysal, Serife; Fredette, Meghan E.; Topor, Lisa Swartz

doi:10.1111/pedi.12559

Cited by 9 publications

(6 citation statements)

References 30 publications

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“…We identified 395 episodes of DKA over 7.5 years, with average age 12.7 years (range 0.6-17.9 years). As described previously, 214 of the 395 DKA episodes occurred in males (54%), and 176 episodes occurred in those with new onset diabetes mellitus (NODM) (45%) [7].…”

Section: Resultssupporting

confidence: 59%

“…Methods. We performed a retrospective cohort study of children 0 to <18 years admitted to Hasbro Children's Hospital for pediatric DKA, between January 1, 2009, and July 31st, 2016, as previously described [7]. DKA was defined in accordance with the International Society of Pediatric and Adolescent Diabetes (ISPAD) consensus guidelines: pH ≤ 7.3 or bicarbonate ≤15 mEq/L (15 mmol/L), with blood glucose ≥200 mg/dl (11.1 mmol/L), and ketosis or ketonuria [8].…”

Section: Case Presentationmentioning

confidence: 99%

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The Incidence of Erosive Esophagitis as a Complication of Pediatric Diabetic Ketoacidosis

Agrawal

Uysal

Fredette

et al. 2021

Case Reports in Endocrinology

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Introduction. Gastrointestinal (GI) symptoms commonly occur during diabetic ketoacidosis (DKA) and typically resolve with treatment. However, GI complications can persist after DKA resolves. The incidence of upper GI bleeding during DKA in adults has been described, with erosive esophagitis one of the most common lesions. The incidence of GI bleeding or erosive esophagitis in children with DKA has not been previously reported. We performed a retrospective chart review of DKA admissions in children 0 to <18 years with type 1 diabetes mellitus (T1DM) at a pediatric hospital between January 2009 and July 2016. Among 395 episodes of DKA over 7.5 years, erosive esophagitis occurred during two DKA admissions (0.5%) and there were no episodes of GI bleeding. Case presentations. Both episodes of erosive esophagitis occurred in adolescent males with known T1DM who presented with severe DKA. Both developed odynophagia after resolution of DKA and were readmitted for DKA recurrence. Upper endoscopy for both patients showed erosive esophagitis. Biopsies were negative for infection, though candida was found during one patient’s endoscopy. Both had resolution of their esophagitis symptoms with medication management; neither has had recurrence. Conclusion. Erosive esophagitis, a rare complication of pediatric DKA, can manifest with odynophagia or substernal chest pain. This complication can lead to DKA recurrence, likely due to increased insulin resistance from inflammation and pain and from reduced oral intake and insulin administration. Patients with odynophagia associated with DKA should be monitored closely to allow timely evaluation and treatment of esophagitis.

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Section: Resultssupporting

confidence: 59%

Section: Case Presentationmentioning

confidence: 99%

The Incidence of Erosive Esophagitis as a Complication of Pediatric Diabetic Ketoacidosis

Agrawal

Uysal

Fredette

et al. 2021

Case Reports in Endocrinology

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“…To date, only four patients, one adult and three children, have been reported to develop urinary stones upon DKA admission ( 11 , 13 ). Of the three children with new-onset T1D, 24-h urine collection was performed in two, revealing that one child had high urine sodium levels and the other had low urine citrate excretion ( 11 ). In a study by Yuno et al .…”

Section: Discussionmentioning

confidence: 99%

“…Considering these reports, DKA-induced severe dehydration, hyperglycemia, and acidosis may predispose patients with diabetes mellitus to urinary stone formation. However, to date, urinary stones have been reported in three pediatric DKA cases ( 11 ). A 24-h urine collection was performed for two of the three children.…”

Section: Introductionmentioning

confidence: 99%

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Urinary stone in a 12-year-old adolescent with new-onset type 1 diabetes and diabetic ketoacidosis

Ushijima-Fuchino

Koga

Umino

et al. 2022

Clin Pediatr Endocrinol

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. Dehydration and acidosis increase the risk for urinary stone formation. Urinary stones have been reported in three pediatric cases of diabetic ketoacidosis (DKA). A 24-h urine collection was performed for two of the three children. One patient had high urine sodium levels, while the other had low urine citrate excretion. We report the case of a 12-yr-old adolescent boy with urinary stones, new-onset type 1 diabetes mellitus (T1D), and DKA, excluding other metabolic disorders. After DKA was diagnosed, the patient received a 0.9% saline bolus and continuous insulin infusion. Hyperglycemia and ketoacidosis were well-controlled on the third day after admission. However, the patient developed abdominal pain radiating to the back. Urinary stones were suspected, and a urinalysis was performed. The patient’s urine revealed significant elevation in red blood cells and calcium oxalate crystals. Computed tomography revealed a high-density left ureteric mass, suggestive of a urinary stone. Although both the previously reported pediatric cases involved metabolic diseases, additional tests in this patient excluded metabolic diseases other than T1D. DKA may be related to the formation of calcium oxalate crystals owing to dehydration and acidosis. Therefore, physicians should consider urinary stone formation in DKA patients.

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Diseases and Comorbid Conditions Predisposing Children to Kidney Stones

Winoker

Matlaga

2022

Diagnosis and Management of Pediatric Nephrolithiasis

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Nephrolithiasis: A complication of pediatric diabetic ketoacidosis

Cited by 9 publications

References 30 publications

The Incidence of Erosive Esophagitis as a Complication of Pediatric Diabetic Ketoacidosis

The Incidence of Erosive Esophagitis as a Complication of Pediatric Diabetic Ketoacidosis

Urinary stone in a 12-year-old adolescent with new-onset type 1 diabetes and diabetic ketoacidosis

Diseases and Comorbid Conditions Predisposing Children to Kidney Stones

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