Mortality and Prognostic Factors of Diabetic Ketoacidosis in Children in the Intensive Care Unit (About 142 Cases)

Abstract

Diabetic ketoacidosis is a metabolic emergency and one of the main causes of morbidity and mortality in diabetic children due to its formidable complications. The severity of the evolution is essentially related to the initial clinical state, hence the interest of an early diagnosis and a correct management. In this work we tried to make a global analysis of this disease. We conducted a retrospective study of 122 cases admitted to the pediatric intensive care unit at the Ibn Rochd University Hospital in Casablanca between January 2010 and January 2020. The different variables collected at admission were analyzed and compared between two groups: patients who died and those who survived. 122 cases of diabetic ketoacidosis were identified. 68 boys and 74 girls with a sex ratio of 0.91. The average age was 7.61 years. Ketoacidosis was inaugural in 62% of cases, polyuoro-polydipsic syndrome was found in all patients followed by digestive disorders and 55.6% of cases. The average GCS on admission was 12. Shock was found in 17.6% of the cases and polypnoea with Kussmaul type respiration in 71.12% of the cases. The mean values of kalaemia and natraemia were close in both groups. Bicarbonates were below normal in all patients with an average of 6.37 mmol/l. The mortality was 15%. The treatment consisted of adequate rehydration associated with insulin therapy, following the protocol of the department. Our study shows that the diagnosis of DKA must be made early and requires a well codified management. Hence the interest in raising awareness and educating physicians and the population about the signs of diabetes in children in order to reduce the frequency and severity of pediatric DKA.