Risk Factors for Cerebral Edema and Acute Kidney Injury in Children with Diabetic Ketoacidosis

Abstract

A bstract Objectives To study the clinical profile and risk factors of cerebral edema and acute kidney injury in children with diabetic ketoacidosis. Design Retrospective review of medical records. Patients Fifty consecutive patients (age <18 years) admitted to our pediatric intensive care unit with a diagnosis of diabetic ketoacidosis over 5 years. Materials and methods Retrospective analysis of medical records was done, and data including patients’ age, sex, presenting features, biochemical profile including blood glucose, osmolality, urea, creatinine, and venous blood gas, electrolytes were recorded at admission, at 12 and 24 hours. Treatment details including fluid administration, rate of fall of glucose, time to resolution of diabetic ketoacidosis were noted. Complications such as cerebral edema and acute kidney injury were recorded. Patients with and without cerebral edema and acute kidney injury were compared. Variables that were significant on univariate analysis were entered in a multiple logistic regression analysis to determine the independent predictors for cerebral edema and acute kidney injury. Odds ratio and 95% confidence interval were calculated using SPSS version 22. Measurements and main results Between November 2015 and 2020, 48 patients were admitted for a total of 50 episodes of diabetic ketoacidosis. Two patients had recurrent diabetic ketoacidosis. Median age was 9.5 years (range 1–17). Thirty-one patients (62%) had new-onset type I diabetes mellitus. Twenty-two patients (44%) presented with severe diabetic ketoacidosis. Cerebral edema and acute kidney injury were seen in 11 (22%) and 15 (30%) patients, respectively. On multiple logistic regression analysis, higher blood urea level, lower serum bicarbonate level, and higher corrected sodium levels at admission were identified to be variables independently associated with risk of cerebral edema. Conclusions Higher corrected sodium, higher urea level, and lower serum bicarbonate levels at admission are predictive of cerebral edema in patients presenting with diabetic ketoacidosis. The severity of dehydration and acidosis in DKA appears to be a common factor responsible for the development of dysfunction of both brain and kidney. How to cite this article Raghunathan V, Jevalikar G, Dhaliwal M, Singh D, Sethi SK, Kaur P, et al. Risk Factors for Cerebral Edema and Acute Kidney Injury in Children with Diabetic Ketoacidosis. Indian J Crit Care Med 2021;25(12):1446–1451.

The effect of serum biochemical parameters on clinical prognosis in children presenting with diabetic ketoacidosis

“…Previous studies have reported that approximately 30–60% of patients present with DKA at the time of initial diagnosis, while DKA is identified in 7–10% of patients during follow-up 2 - 4 . Prolonged or complicated DKA can lead to organ dysfunction, prolonged hospitalization, and increased treatment costs 5 . Severe acidemia in DKA leads to decreased cardiac contractility, cardiac arrhythmias, and hemodynamic instability, and is the leading factor affecting clinical prognosis due to the damage sustained by vital organs (brain and kidneys).…”

“…Severe acidemia in DKA leads to decreased cardiac contractility, cardiac arrhythmias, and hemodynamic instability, and is the leading factor affecting clinical prognosis due to the damage sustained by vital organs (brain and kidneys). Acidosis also inhibits the binding of insulin to its receptor and the reduction in ketone formation 5 - 7 . DKA develops suddenly, progresses rapidly, and is accompanied by life-threatening complications, with mortality rates of 5% reported 8 .…”

Analysis the level of autoantibodies in diabetic ketoacidosis in pediatric practice

“…Диабетический кетоацидоз (ДКА) является острым и наиболее опасным осложнением СД 1-го типа [1]. ДКА имеет тяжелые последствия для детского организма, в первую очередь за счет поражения центральной нервной системы (ЦНС) [3]. Научные исследования продемонстрировали, что максимально ранний скрининг аутоантител (ААТ) к β-клеткам поджелудочной железы у детей на преддиабетической стадии СД 1-го типа может существенно снизить риски проявления ДКА, что приведет к уменьшению частоты госпитализаций при данном осложнении [1].…”

“…Максимальные клинические нарушения уровня сознания и биохимических показателей выявлены у детей с ДКА 3-й степени. У всех пациентов с ДКА диагностировано повышение средних значений ААТ как к NMDAR1 -3,82 [3,[0][1][2][3][4][5]59] ЕД/мл, по сравнению с условно здоровыми детьми -1,12 [0,65-1,64] ЕД/мл (р = 0,000), так и к ААТ к DAR2 -7,24 [3,19] ЕД/мл, по сравнению с пациентами из группы контроля -2,13 [1,45-3,15] ЕД/мл (р = 0,000). Обнаружено, что степень повышения ААТ к NMDAR1 и DAR2 зависела от клинической тяжести ДКА (максимальные концентрации выявлены при ДКА 3-й степени).…”

Avaliação da injúria renal aguda e de parâmetros bioquímicos em crianças e adolescentes com cetoacidose diabetica tratados com fluidoterapia inicial mais agressiva

“…No nosso estudo, entretanto, não foi o foco o seguimento dos pacientes para avaliação posterior da sustentação de lesão renal por meio da presença de microalbuminúria. Essa análise pode ser retomada em momento posterior.Outros estudos publicados com enfoque na IRA em pacientes pediátricos com CAD trazem achados semelhantes em relação à prevalência de IRA, fatores de risco para seu desenvolvimento, comportamento dos achados clínicos e laboratoriais aos já discutidos em diferentes populações: Arábia Saudita, Canadá, Coréia do Sul, Egito, Estados Unidos, Índia, Israel, Polônia[64][65][66]68,69,[71][72][73][74][75][76][77][78][79] . Porém, o nosso é o primeiro no Brasil e com protocolo de tratamento distinto.…”