Abstract
BackgroundThis study is to explore the clinical characteristics, laboratory diagnosis, and treatment outcomes in pediatric patients with non-diabetic ketoacidosis.MethodsRetrospective patient chart review was performed between March 2009 to March 2015. Cases were included if they met the selection criteria for non-diabetic ketoacidosis, which were: 1) Age ≤ 18 years; 2) urine ketone positive ++ or >8.0 mmol/L; 3) blood ketone >3.1 mmol/L; 4) acidosis (pH < 7.3) and/or HCO3 < 15 mmol/L; 5) random blood glucose level < 11.1 mmol/L. Patients who met the criteria 1, 4, 5, plus either 2 or 3, were defined as non-diabetic ketoacidosis and were included in the report.ResultsFive patients with 7 episodes of non-diabetic ketoacidosis were identified. They all presented with dehydration, poor appetite, and Kussmaul breathing. Patients treated with insulin plus glucose supplementation had a quicker recovery from acidosis, in comparison to those treated with bicarbonate infusion and continuous renal replacement therapy. Two patients treated with bicarbonate infusion developed transient coma and seizures during the treatment.ConclusionDespite normal or low blood glucose levels, patients with non-diabetic ketoacidosis should receive insulin administration with glucose supplementation to correct ketoacidosis.
Highlights
This study is to explore the clinical characteristics, laboratory diagnosis, and treatment outcomes in pediatric patients with non-diabetic ketoacidosis
Some patients with ketoacidosis may have no medical history of diabetes and have normal or low blood glucose levels
Our selection criteria were based on the consensus guideline for pediatric diabetic ketoacidosis [5], except that the blood glucose level was low or normal: 1) age ≤ 18 years; 2) urine ketones positive ++ or >8.0 mmol/L; 3) blood ketone level > 3.1 mmol/L; 4) acidosis; 5) random blood glucose level < 11.1 mmol/L
Summary
This study is to explore the clinical characteristics, laboratory diagnosis, and treatment outcomes in pediatric patients with non-diabetic ketoacidosis. Some patients with ketoacidosis may have no medical history of diabetes and have normal or low blood glucose levels. These patients with non-diabetic ketoacidosis may experience severe complications or even death [1]. There has been very limited research involving patients with non-diabetic ketoacidosis, especially those in the pediatric age-group. Diabetic ketoacidosis requires intravenous fluid replacement, insulin injection, correction of electrolyte imbalance, and possible bicarbonate administration in patients with severe acidosis, as well as prompt treatment for its etiology such as infection or insufficient insulin administration [2]
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