The factors affecting resolution of acidosis in children with diabetic ketoacidosis - A retrospective study from a tertiary care center in India

Abstract

Background: Diabetic ketoacidosis (DKA) is characterized by a spectrum of clinical manifestations due to deficiency of insulin which results in hyperglycemia, ketonemia with ketonuria, and metabolic acidosis. Administration of insulin inhibits the production of keto acids and facilitates their metabolism, thereby helps in correcting the acidosis. However, in some situations, the acidosis takes longer to get corrected. Objectives: The aim of this study is to evaluate the factors at admission predicting the duration of acidosis in a child presenting with DKA. Methods: Study Type: This was a retrospective case record review. Inclusion Criterion: All children <15 years who were admitted under the pediatric intensive care unit of a tertiary care hospital from April 2012 to January 2016 with DKA were included in this study. Their demographic data, investigations, treatment details, and length of hospital stay were noted in a predesigned pro forma. Prolonged acidosis was defined as acidosis taking longer than 24 h to resolve. Results: Forty-eight cases met the inclusion criteria; of the 48 cases, 27 (56%) had prolonged acidosis. The median duration of correction of acidosis was 31 h (interquartile range 18.75-48 h/range of 6-192 h). On univariate analysis, children with prolonged acidosis had a low pH (7.1 vs. 7.25), a low serum bicarbonate (4.69 vs. 7.49 mEq/L), base excess (?22.7 vs ?17.04), a high total leukocyte count (TLC) (24,275 vs. 13,557 cells/mm3), and platelet count (450,651 vs. 316,140 cells/mm3) at admission (t-test, p<0.05). On stepwise logistic regression analysis, only low pH and a high TLC were associated with prolonged acidosis.The presence of rhabdomyolysis and myocardial impairment and degree of dehydration at admission which could contribute to prolonged acidosis were not measured in this study. Conclusion: Prolonged acidosis (lasting more than 24 h) was associated with a high TLC and a low pH at admission.