Outcomes of Children and Adolescents Admitted with Diabetic Ketoacidosis at Kenyatta National Hospital (KNH), Kenya

Abstract

Background. Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication that mainly occurs in patients with type 1 diabetes mellitus and is the foremost cause of death in these children. Overall mortality in children with DKA varies from 3.4% to 13.4% in developing countries. There is a need to understand outcomes among children with DKA in sub-Saharan African countries. Objective. To determine the death rate and clinical outcomes of children and adolescents aged 0-18 years managed for DKA at Kenyatta National Hospital (KNH). Study Methods. This was a retrospective study carried out among children aged 0–18 years admitted with DKA at KNH between February 2013 and February 2018. The study site was the central records department at KNH. The inclusion criteria were children aged 0-18 years admitted with a diagnosis of DKA based on the ISPAD guidelines biochemical criteria. Results. Out of the 159 files reviewed, the median age of children was 13 years (IQR 10-15). 41.1% of patients had severe DKA while 35.7% had moderate DKA. We reported a mortality of 6.9% while 93.1% of children recovered and were discharged home. The median duration of hospital stay was 8 days. High risk of mortality was reported among children who had high serum creatinine (OR 5.8 (95% CI 1.6-21.2)), decreased urine output (OR 9.0 (95% CI 2.2-37.3)), and altered level of consciousness (OR 5.2 (95% CI 1.1-25.1)). Conclusion. DKA-associated mortality in our study was low at 6.9%. High serum creatinine, decreased urine output, and altered level of consciousness were associated with a significantly higher risk of mortality.

Diabetic Ketoacidosis in Children with Type-1 Diabetes in a Tertiary Hospital in Sokoto, North-Western Nigeria: Clinical Profile and Outcome

“…Their conclusion was supported by their findings of a female: male ratio amongst the newly diagnosed T1D (with DKA) of closer to an equal sex distribution, and the number of admissions involving females with recurrent episodes of DKA being almost double that of males. Majority of our study population were adolescents aged 10-15years, in agreement with reports from Nigeria [10,29], other African countries [1,19] and Asia [5,26,27], probably because majority of our study population were 10 years and above at the time of diagnosis of T1D and they either presented with DKA at time of diagnosis or at a later time, thus diabetes was more frequently diagnosed in adolescents than younger children in our series and this also applies to DKA, a complication of T1D.…”

“…The clinical features observed are similar to those reported in studies from Nigeria [10,11,14,17], other parts of Africa [1,19], and Asia [5,26,27], with only slight differences, particularly in the order of frequency. Whilst abdominal pain was the commonest symptom in our study, similar to a study in Himalayan, North India [26], polyuria [5,10,14,18], respiratory distress [19,27] and vomiting [27], were the commonest symptoms reported from studies within{10, 14, 18} and outside Nigeria [5,19,27].…”

“…Diabetic ketoacidosis (DKA) is an acute, major, life threatening complication that mainly occurs in patients with type 1 diabetes (T1D), and is the foremost cause of death in these patients [1]. It is the end result of the metabolic abnormalities resulting from a severe deficiency of insulin or insulin effectiveness, the latter occurs during stress, as counter regulatory hormone block insulin action [2].…”

“…There are few reports on DKA in the childhood diabetic population in Nigeria [10,14,[17][18] and other African countries [1,19,20]. Most of these reports focused on DKA at onset of T1D only.…”

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

“…This is because having concurrent infection has an in uence on diabetes disease progress with impairment of glucose metabolism possibly lead to deterioration of glycemic control. Infection might also cause high level of counteracting hormones which triggering an episode of hyperglycemia and which may complicate uid and electrolyte replacement therapy protocol with concurrent treatment for infectious conditions to avoid possible life-threatening drug interactions (32).The nding is supported with the studies conducted in Addis Ababa, Jimma and Kenya (18,22,25) A client with abdominal pain during presentation is 4.28 times more likely to be stayed in the hospital than clients with no symptoms of abdominal pain during their presentation (AOR=4.28, 95%CI=1.11 -15.52). The nding is in line with the study conducted in Kenya (25) and Turkey (45).…”