Abstract
Background: Severe hypoglycemia is a lifethreatening iatrogenic complication in the management of diabetic ketoacidosis, however, few studies have described how often this complication occurs. Objective: To identify the risk factors for severe hypoglycemia in children treated for diabetic ketoacidosis and to describe the sociodemographic, clinical characteristics and outcome of these children. Methods: From January 2013 to December 2017, 69 children admitted to pediatric intensive care unit with a diagnosis of diabetic ketoacidosis were enrolled in a retrospective and prospective study. Data of children with and without severe hypoglycemia were compared. Data were analyzed using Epi Info 7.1.5.0. Results: Out of 69 children enrolled, 10 (14.5%) had severe hypoglycemia (girls: 60%, median age 144 months (interquartile range, 108 - 168 months)). Episodes of severe hypoglycemia occurred during the first 48 hours of hospitalization in 8 (80%) children and during the late night shift in 6 (60%) children. Causes of severe hypoglycemia were: excessive insulin dose (60%), inappropriate infusion solution (70%), failure to properly monitor blood glucose levels (40%). Severe hypoglycemia risk factors were: age p = 0.00004; OR = 42.0 [95% CI: 6.3 - 279]) and severe malnutrition (p = 0.002; OR = 10.9 [95% CI: 2.4 - 48.6]). Of 8 (11.6%) children died, 4 had severe hypoglycemia (p = 0.01; OR = 8.8 [95% CI, 1.7 - 44.8]). Conclusion: The importance and severity of severe hypoglycemia require preventive measures to control risk factors.
Highlights
To identify the risk factors for severe hypoglycemia in children treated for diabetic ketoacidosis and to describe the sociodemographic, clinical characteristics and outcome of these children
Some authors still report cases of hypoglycemia in children while in care for diabetic ketoacidosis, and sometimes in significant numbers [12] [13] [14]. These studies do not provide enough information regarding severe hypoglycemia; the fundamental reason is not well understood: One wonders if the scarcity is lack of cases, under recording or rather a matter simple trivialization? In Brazzaville (Republic of Congo), a previous study of children treated for diabetic ketoacidosis reported the frequency of severe hypoglycemia at 27.2% [3]
Data related to: sex, age, socio-economic status, personal and family history of diabetes, nutritional status, level of consciousness assessed using the Glasgow coma scale [17], blood glucose readings on admission and during hospitalization, insulin dosage administered on admission and during hospitalization, type intra venous (IV) fluids used, the outcome, were all collected using a standardized pre-established survey form by way of interviewing the parents/legal guardians and the child him/herself when possible and from medical records
Summary
Severe hypoglycemia in diabetic children is usually the result of excessive insulin supply on one hand and, insufficient carbohydrates intake and/or inadequate counter-regulatory hormone response on the other hand. It has been mainly studied in ambulatory settings [9] [10]. It is worth noting that, improved insulin quality, the insulin therapy and state of the art blood glucose monitoring systems have all contributed to a general decreased of its incidence worldwide [9] These same measures coupled with a timely glucose intake have shown the same effect on the incidence of hypoglycemia during diabetic ketoacidosis [5] [11]. The main purpose of this study was to identify the risk factors associated with hypoglycemia in children treated for diabetic ketoacidosis and to determine the sociodemographic, clinical, characteristics and outcome of these children
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