Rare complications of pediatric diabetic ketoacidosis

Abstract

The incidence of type 1 diabetes (T1D) among youth is steadily increasing across the world. Up to a third of pediatric patients with T1D present with diabetic ketoacidosis, a diagnosis that continues to be the leading cause of death in this population. Cerebral edema is the most common rare complication of diabetic ketoacidosis in children. Accordingly, treatment and outcome measures of cerebral edema are vastly researched and the pathophysiology is recently the subject of much debate. Nevertheless, cerebral edema is not the only sequela of diabetic ketoacidosis that warrants close monitoring. The medical literature details various other complications in children with diabetic ketoacidosis, including hypercoagulability leading to stroke and deep vein thrombosis, rhabdomyolysis, pulmonary and gastrointestinal complications, and long-term memory dysfunction. We review the pathophysiology, reported cases, management, and outcomes of each of these rare complications in children. As the incidence of T1D continues to rise, practitioners will care for an increasing number of pediatric patients with diabetic ketoacidosis and should be aware of the various systems that may be affected in both the acute and chronic setting.

Prevalence of abnormal serum sodium and potassium concentration in paediatric new onset type 1 diabetes with ketoacidosis: A retrospective study from two Nigerian Teaching Hospitals

“…In the presence of hyperglycemia, an elevated or normal serum sodium concentrations indicate a clinically significant deficit in total body water (8). The report of one study suggested that high serum sodium and glucose levels represent the most important determinants for the occurrence of rhabdomyolysis (9), a known rare complication of DKA (4,10). In a study in USA involving children aged below 17 years with DKA, 33% of the patients had hypernatremia (11).…”

“…Although it is estimated that a total body potassium deficit of 3-6mmol/kg occurs at presentation of DKA, pretreatment serum potassium levels are usually normal due to the intracellular shift of potassium that occurs with metabolic acidosis and insulin deficiency (10). In this regard, hypokalemia occurs only in 5-10% of patients at presentation of DKA but very rarely is the concentration less than 2.5mmol/L (12,13).…”

“…In this regard, hypokalemia occurs only in 5-10% of patients at presentation of DKA but very rarely is the concentration less than 2.5mmol/L (12,13). The principal factor responsible for DKA-associated potassium depletion is increased renal losses due to the osmotic diuresis and ketoacid anion excretion (10). In addition, insulin plays a major role in mediating muscle potassium uptake to control the plasma potassium concentration (14,15) via regulation of Na+/K+-ATPase activity (6).…”

Nephrolithiasis: A complication of pediatric diabetic ketoacidosis

“…Diabetic ketoacidosis (DKA), characterized by hyperglycemia and acidosis, occurs in children with new onset of type 1 diabetes mellitus (T1DM) with a prevalence of approximately 30% . There are several complications of DKA described in children, including cerebral edema, stroke, pancreatitis, gastritis, pulmonary edema, and rhabdomyolysis . Acute kidney injury (AKI), with a rise in creatinine and uric acid, also occurs frequently in DKA and is likely due to severe dehydration .…”

Diabetic Ketoacidosis: Demographic Data, Clinical Profile and Outcome in a Tertiary Care Hospital

“…Outcome of DKA was defined in terms of death or survival without considering any acute or chronic problems during the one year follow-up, e.g. cerebral edema and related consequences, renal failure, rhabdomyolysis, stroke, deep vein thrombosis (DVT), pneumomediastinum, acute respiratory distress syndrome (ARDS) with pulmonary edema, and gastrointestinal complications (11)(12)(13).…”