Diabetic Ketoacidosis Mortality Research Articles

Serum Amylase as a Prognostic Factor in Diabetic Ketoacidosis

Abstract Objective: The study’s objectives were to learn about the impact of serum amylase levels on morbidity and mortality of diabetic ketoacidosis (DKA) patients. Methodology: This is a single-center cross-sectional study of 100 patients admitted to the Medicine Intensive Care Unit at Shyam Shah Medical College and SGM Hospital Rewa between January 2021 and June 2022. Results: Mean duration of hospital stay in DKA patients with serum amylase level <140 U/L was 10.56± 5.04 days while DKA patients with serum amylase level ≥140 U/L was 23.75 + 1.66 Days. The mean amylase level in death cases of DKA was 198.32 IU/L and in recovered cases of DKA was 87.22 IU/L. Conclusion: In our study, we discovered that as serum amylase levels rise so does the length of hospital stay. Amylase levels were extremely high in death cases.

Sepsis screening tools for predicting infection triggers and outcomes in diabetic ketoacidosis.

Background: An early prediction of infection is challenging in diabetic ketoacidosis (DKA). Methods: This prospective cohort study aimed to assess effectiveness of various sepsis screening tools in predicting infections and prognosis in DKA. Results: Among 141 cases, infection (44.0%) was the commonest precipitating factor. A Sequential Organ Failure Assessmentscore ≥4 showed high specificity (82.28%) and high positive likelihood ratio (2.64) but limited sensitivity (46.77%). Conversely, Systemic Inflammatory Response Syndrome ≥2exhibited good sensitivity (95.16%) but a high false-positive rate (84.28%). National Early Warning Score ≥7 and QuickSequential Organ Failure Assessment ≥2 had low sensitivity and specificity. These sepsis tools also demonstrated low prognostic accuracy for mortality. Conclusion: Sepsis screening tools have limited predictive accuracy for infections and mortality in DKA.

Comprehensive review of diabetic ketoacidosis: an update.

The most frequent hyperglycemic emergency and the leading cause of death in people with diabetes mellitus is diabetic ketoacidosis (DKA). DKA is common in people with type 1 diabetes, while type 2 diabetes accounts for roughly one-third of occurrences. Although DKA mortality rates have generally decreased to low levels, they are still significant in many underdeveloped nations. In industrialized countries, its mortality rate ranges from 2 to 5%, but in underdeveloped nations, it ranges from 6 to 24%. Therefore, it is always lethal if misdiagnosed or improperly treated. According to specific research, DKA can be present at the time of type 1 diabetes onset in 25 to 30% of cases and in 4 to 29% of young people with type 2 diabetes mellitus, and its features include hyperglycemia, metabolic acidosis, and ketosis with its triggering factors commonly being infections, newly discovered diabetes, and failure to start insulin therapy. Less than 20% of DKA patients present comatose, and patients with different levels of consciousness can present at other times. A close association between abnormalities found during a mental status evaluation and osmolality seems to exist. Hospital admission is necessary for vigorous intravenous fluid therapy, insulin therapy, electrolyte replacement, diagnosis and treatment of the underlying triggers, and routine monitoring of the patient's clinical and laboratory conditions to manage DKA properly. Appropriate discharge plans should include actions to prevent a DKA recurrence and the proper selection and administration of insulin regimens.

A UK nationwide study of adults admitted to hospital with diabetic ketoacidosis or hyperosmolar hyperglycaemic state and COVID-19.

To investigate characteristics of people hospitalized with coronavirus-disease-2019 (COVID-19) and diabetic ketoacidosis (DKA) or hyperosmolar hyperglycaemic state (HHS), and to identify risk factors for mortality and intensive care admission. Retrospective cohort study with anonymized data from the Association of British Clinical Diabetologists nationwide audit of hospital admissions with COVID-19 and diabetes, from start of pandemic to November 2021. The primary outcome was inpatient mortality. DKA and HHS were adjudicated against national criteria. Age-adjusted odds ratios were calculated using logistic regression. In total, 85 confirmed DKA cases, and 20 HHS, occurred among 4073 people (211 type 1 diabetes, 3748 type 2 diabetes, 114 unknown type) hospitalized with COVID-19. Mean (SD) age was 60 (18.2) years in DKA and 74 (11.8) years in HHS (p < .001). A higher proportion of patients with HHS than with DKA were of non-White ethnicity (71.4% vs 39.0% p = .038). Mortality in DKA was 36.8% (n = 57) and 3.8% (n = 26) in type 2 and type 1 diabetes respectively. Among people with type 2 diabetes and DKA, mortality was lower in insulin users compared with non-users [21.4% vs. 52.2%; age-adjusted odds ratio 0.13 (95% CI 0.03-0.60)]. Crude mortality was lower in DKA than HHS (25.9% vs. 65.0%, p = .001) and in statin users versus non-users (36.4% vs. 100%; p = .035) but these were not statistically significant after age adjustment. Hospitalization with COVID-19 and adjudicated DKA is four times more common than HHS but both associate with substantial mortality. There is a strong association of previous insulin therapy with survival in type 2 diabetes-associated DKA.

The Influence of Obesity Hypoventilation Syndrome on the Outcomes of Patients With Diabetic Ketoacidosis.

Purpose: The effect of comorbid obesity hypoventilation syndrome (OHS) on hospitalized patients with diabetic ketoacidosis (DKA) has not been studied so far. This study elucidates the outcomes of DKA patients with OHS compared to those without OHS.Methods: Patients above 18 years of age were included in the study. The National Inpatient Sample (NIS) database of 2017 and 2018 was used and data were extracted using the International Classification of Diseases, Tenth Revision (ICD-10) codes; OHS ICD-10 code being “E66.2” and DKA ICD-10 codes being “E08.1, E09.1, E10.1, E11.1, and E13.1.” The comorbid medical conditions were also identified using the ICD-10 codes. Logistic regression analysis was performed to examine the impact of OHS on in-hospital outcomes of DKA patients.Results: OHS was prevalent in 0.61% of the general population, as per the NIS database in the years 2017 and 2018. Primary outcomes of the study were in-hospital mortality, whereas secondary outcomes included acute kidney failure, the requirement for invasive mechanical ventilation, length of stay, and cost of hospitalization. OHS in DKA patients was associated with increased mortality (odds ratio (OR): 4.35 (2.63-7.20), p < 0.00001; adjusted OR (aOR): 1.79 (1.01-3.15), p < 0.044), acute kidney failure (OR: 2.44 (1.79-3.33), p < 0.00001; aOR: 1.43 (1.03-2.00), p < 0.031), invasive mechanical ventilation (OR: 4.17 (2.90-5.98), p < 0.00001; aOR: 1.62 (1.08-2.41), p < 0.017), increased length of stay (10.02 ± 12.42 vs. 4.70 ± 6.31, p < 0.00001), and cost of care (132314 ± 197111.8 vs. 54245.06 ± 98079.89, p < 0.00001). All-cause mortality of patients with DKA and OHS using the Cox proportional hazards ratio was 1.70 (1.02-2.84, p < 0.024) after adjusting for age, race, sex, smoking, obesity, and comorbidities such as heart failure, hypertension, chronic obstructive pulmonary disease, chronic ischemic heart disease, chronic kidney disease, liver disease, and cerebral infarction.Conclusion: OHS is an independent risk factor for mortality in DKA, irrespective of the degree of obesity. Further prospective studies are recommended to study the effects of different treatment modalities of OHS such as identification of the need for early non-invasive ventilation or for early invasive mechanical ventilation to improve outcomes in DKA patients.

Clinical Profile and Outcomes of Diabetic Ketoacidosis during the COVID-19 Pandemic in North India.

Although recent data have shown a declining trend in mortality in diabetic ketoacidosis (DKA), the outcomes are likely to be different during the coronavirus (COVID-19) pandemic. We conducted a prospective cohort study to evaluate the spectrum and outcomes of adult DKA during the pandemic and document differences in DKA patients with or without COVID-19. A total of 169 patients (mean age 44 years) were admitted at the Emergency Department of PGIMER, Chandigarh (India), from January 2020 to June 2021. The precipitating factors were noncompliance with antidiabetic therapy (77.5%), infections (62.7%), and noninfectious conditions (21.3%). Thirty-nine (23.1%) patients had COVID-19, including 31 with severe infection. DKA severity and resolution, ventilator requirement, hospital stay, and mortality were similar in the patients with or without COVID-19. In-hospital mortality was 39.6% (n = 67). The independent mortality predictors were ventilator requirement (p-0.000), an infection trigger (p-0.049), and hyperosmolarity (p-0.048). DKA mortality is increased significantly during the pandemic.

Incidence and prevalence of type 1 diabetes and diabetic ketoacidosis in children and adolescents (0–19 years) in Thailand (2015–2020): A nationwide population-based study

SummaryBackgroundThere is a lack of published studies on incidence of type 1 diabetes (T1D) and diabetic ketoacidosis (DKA) in Thailand. We aimed to estimate the national prevalence and incidence of T1D and DKA.MethodsUsing Thailand's nationwide population-based longitudinal data covering 69 million individuals, we included the entire children and adolescents recorded in the database. Diseases were identified using ICD-10 codes. We investigated the prevalence of T1D and cumulative incidence of T1D, T1D referral, DKA, and mortality risk of DKA in five years from 2015 to 2020. T1D and DKA annual incidence were also estimated. We present findings for the total population and by sex, age, and urban-rural residencies.FindingsA total of 19,784,781 individuals aged less than 20 years were identified in 2015. The crude T1D prevalence in 2015 was 17·6 per 100,000 and crude T1D incidence rate was 5·0 per 100,000. T1D prevalence and cumulative incidence were significantly higher in older children (p < 0·001) and females (p < 0·001) than their counterparts. Among those with T1D, cumulative incidence of T1D referral was 42·4%. It was highest amongst children aged 5–14 years and was significantly higher among females (all p < 0·05). The crude DKA incidence rate at any point after diagnosis was 10·8%. The cumulative incidence of DKA was significantly higher in females and peaked in individuals aged 5–14 years (all p < 0·001). The DKA mortality risk was 258·2 per 100,000.InterpretationOlder children and females had higher T1D prevalence. The DKA cumulative incidence and mortality risk were relatively low, and such incidence was peak in individuals aged 5–14 years.FundingHarvard University.

The Red Blood Cell Distribution Width-Albumin Ratio Was a Potential Prognostic Biomarker for Diabetic Ketoacidosis.

BackgroundThe red blood cell distribution width (RDW)–albumin ratio (RA) is a new biomarker, which is d-efined as RDW divided by albumin. This study aimed at determining the prognostic values of RA for diabetic ketoacidosis (DKA).MethodsData were obtained from Medical Information Mart for Intensive Care Database III V1.4 (MIMIC-III) and the RA calculated. Multivariate Cox regression analysis was performed to determine the correlation between RA and 90-day mortality or 365-day mortality. To further investigate the association with RA and mortality, the patients were divided into two groups. The second outcome was the association between the incidence of DKA-related infections and RA.ResultsFor DKA patients in the ICU, RA was significantly correlated with 90-day mortality (HR: 2.1, 95% CI: 1.5, 3.0, p < 0.001) and 365-day mortality (HR: 1.9, 95% CI: 1.5, 2.5, p < 0.001). A high RA was independently correlated with increased 90-day mortality (HR: 7.8, 95% CI: 1.8, 34.0, p for trend <0.001) and 365-day mortality (HR: 5.2, 95% CI: 2.4, 11.3, p for trend <0.001). Moreover, RA was found to be an independent predictor for sepsis and septic shock in patients with DKA (HR: 2.9, 95% CI: 2.0, 4.1, p < 0.001). After adjusting for confounders, the statistical outcome was the same.ConclusionA high RA is significantly correlated with increased all-cause mortality of DKA as well as an increased incidence of DKA-related infections. RA is a potential prognostic marker for DKA.

Performance of the APACHE II and SOFA Scores in Diabetic Ketoacidosis.

Accurate prediction of severity and mortality in diabetic ketoacidosis (DKA) is important for allocation of resources. The APACHE II and SOFA scores are used to predict mortality in critically ill patients, however neither has been tested exclusively in DKA. We sought to determine if these scoring systems can accurately predict mortality in patients with DKA. This was an observational study of patients presenting to an urban tertiary care center with a diagnosis of DKA. Adult patients (age ≥ 18 years) with glucose > 250 mg/dL, bicarbonate ≤ 20 mEg/L, an anion gap ≥ 16 mEg/L, pH ≤ 7.30, and urine ketones were included. Predicted mortality based upon APACHE II and SOFA scores were compared to observed mortality. A total of 50 patients were included. There was no observed mortality in our population. The median APACHE II score was 10 (IQR: 6, 15) which predicted a mortality of 15% and the median SOFA score was 1 (IQR: 0, 2) which predicted a mortality of 0%. In summary, we found the APACHE II illness severity score does not accurately predict mortality in a population of patients with DKA, while the SOFA score appears to predict mortality in the same population.

A Prediction Model of Mortality in Patients Hospitalized with Diabetic Ketoacidosis in a Tertiary Referral Hospital in Surabaya, Indonesia

Background: The mortality rate of diabetic ketoacidosis (DKA) remains high in Indonesia. Differentpatterns were contributing to DKA mortality from previous studies. We aim to identify clinical and laboratoryfindings as mortality predictors of DKA.Methods: This retrospective study was conducted in a tertiary referral hospital in Surabaya. Medical recordsof DKA patients from January 2016 to December 2018 were analyzed. Clinical and laboratory data wereobtained from medical records for three years period. Clinical outcome was defined as either dischargedhome or death.Results: Fifty-six among 116 DKA patients did not survive during hospitalized. Age of 60 or older, thedepressed mental state with GCS below 13, potassium serum less than 3.5 mmol/L, and bicarbonate serumless than 15 mmol/L are found to be significant as independent factors of mortality in DKA patients.Conclusion: The mortality rate of DKA patients in this study is still high. It independently associatedwith the age of 60 years or older, depressed mental state, hypokalemia, and low bicarbonate level. Earlystratification of these predictors would help to treat patients accordingly.

Association between red blood cell distribution width and mortality in diabetic ketoacidosis.

BackgroundNo epidemiological studies have assessed the impact of red blood cell distribution width (RDW) on the prognosis of diabetic ketoacidosis (DKA) patients in the intensive care unit (ICU). Thus, we investigated whether RDW was associated with mortality in DKA patients.Material and methodWe analyzed data from MIMIC-III. RDW was measured at ICU admission. The relationship between RDW and mortality of DKA was determined using a multivariate Cox regression analysis. The primary outcome of the study was 365-day mortality from the date of ICU admission. We also conducted a subgroup analysis to further confirm the consistency of associations.ResultsIn total, 495 critically ill DKA patients were eligible for analysis. In the univariable Cox regression model for 365-day all-cause mortality, RDW was a predictor of all-cause mortality in DKA patients (hazard ratio [HR]: 1.30, 95% confidence interval [CI]: 1.19–1.43). After adjusting for confounders, RDW was still a particularly strong predictor (HR: 1.23, 95% CI: 1.05–1.45). The same relationship was also observed for 90-day all-cause mortality (HR: 1.29, 95% CI: 1.02–1.65).ConclusionsHigh RDW was associated with risk of all-cause mortality in DKA patients in the ICU. RDW was an independent prognostic factor for these patients.

The incidence, risk factors, and long-term outcomes of acute kidney injury in hospitalized diabetic ketoacidosis patients

BackgroundEmerging evidence has demonstrated that acute kidney injury (AKI) is an important risk factor associated with increased morbidity and mortality in diabetic ketoacidosis (DKA) patients. The current study aimed to investigate the incidence rate, risk factors, long-term renal outcomes, and mortality in DKA patients with AKI.MethodsA total of 179 patients diagnosed with DKA at Sun Yat-sen Memorial Hospital from January 2012 to January 2018 were included in the analysis. AKI was diagnosed according to the 2012 KDIGO criteria. Risk factors, long-term renal outcomes, and mortality were analyzed by logistic regression and Cox proportional hazards models.ResultsAmong 179 DKA patients, 98 patients (54.75%) were diagnosed as AKI. Aging; increased blood glucose, serum uric acid and white blood cells; decreased serum pH and albumin; coma; and preexisting chronic kidney disease (CKD) were risk factors of AKI in patients with DKA. During follow-up, DKA patients with AKI showed more than a two-fold decline in eGFR within 1 year after discharge from the hospital when compared with non-AKI DKA patients. Furthermore, AKI was also an independent risk factor for poor long-term renal outcomes and mortality in DKA patients.ConclusionsMultiple risk factors contribute to the development of AKI in DKA patients. AKI and advanced AKI stage are associated with rapid progressive CKD and long-term mortality in patients with DKA.

Risk factors for poor outcome in diabetic keto acidosis at the initial presentation among children with type 1 diabetes mellitus

Background: Diabetic keto acidosis (DKA) is a serious metabolic disorder among children with new onset Type 1 Diabetes mellitus and is associated with high morbidity and mortality. Objective of the present study was to assess the risk factors associated with mortality in DKA at its initial presentation among children with new onset type 1 diabetes mellitus (T1DM).Methods: A case control study was designed and conducted in the Institute of child Health and Hospital for children, Madras Medical College, Chennai from February 2013 to February 2015. All children admitted with DKA as initial presentation of type 1 Diabetes mellitus were enrolled for this study.Results: Out of 72 new cases of T1DM, diagnosed during the study period 47 children had DKA and 25 children presented without DKA. Of the 47 children 6 children died. On comparing risk factors for mortality in DKA at the initial presentation, delayed treatment(p-0.002), altered sensorium at presentation(p-0.04), high urea(p-0.014) creatinine(p-0.042), lower bicarbonates (p-0.035), higher sodium(p-0.025) and lower pH(p-0.009) were found to be significantly associated with mortality. Overall mortality in DKA at its initial presentation is 12.8%.Conclusions: Delay in therapy for DKA and presence of features of severe disease at admission are significant risk factors for mortality.

The Study of Different Clinical Pattern of Diabetic Ketoacidosis and Common Precipitating Events and Independent Mortality Factors.

Diabetic Ketoacidosis (DKA) is an important cause of morbidity and mortality among diabetic patients in spite of major advances in the pathogenesis and more standardized diagnosis and treatment. To find out the different patterns of clinical presentations, common precipitating factors and independent mortality factors in DKA. This study was conducted in a tertiary care hospital, Mysuru on 110 patients from November 2007 to October 2009. Clinical presentation and precipitating factors of DKA were monitored. Univariate analysis was done to identify statistically significant risk factors contributing to DKA mortality and was used for multiple logistic regressions to identify independent mortality predictors. A scoring methodology was used to identify the risk of having multiple risk factors in an individual. In this study, the mean age was 42.33 years, with a male to female ratio of 1.2:1. The most common complaints were vomiting and generalized weakness seen in 55 (50%) and 49 (44.5%) cases respectively. The most common precipitating factors were infections and poor compliance to antidiabetic treatment seen in 57 (52%) and 23 (21%) cases respectively. The predictors of mortality included age equal to or more than 65 years, Depressed Mental State (DMS) in the first 24 hour, insulin requirement equal to or more than 50 units in the 12 hours to bring blood glucose to less than 300 mg%, fever in the first 24 hours, shock in the first 24 hours, RBS persistently equal to or more than 300 mg% even after 12 hours with standard treatment protocol, fluid requirement equal to or more than 6 L in the first 24 hours, pH less than 7.2 and bicarbonate less than 15 mmol/l at presentation were statistically significant predictors of mortality. Multivariate analysis failed to identify an independent mortality factor; but, adverse parameters of more than 5 was significantly associated with death. Risk stratification of patients with DKA is possible from simple clinical and laboratory variables available during the first day of hospitalization and further channeling the patients to ICU at the correct time to prevent mortalities.

Risk of death following admission to a UK hospital with diabetic ketoacidosis.

Aims/hypothesisThe aim of this study was to assess the risk of death during hospital admission for diabetic ketoacidosis (DKA) and, subsequently, following discharge. In addition, we aimed to characterise the risk factors for multiple presentations with DKA.MethodsWe conducted a retrospective cohort study of all DKA admissions between 2007 and 2012 at a university teaching hospital. All patients with type 1 diabetes who were admitted with DKA (628 admissions of 298 individuals) were identified by discharge coding. Clinical, biochemical and mortality data were obtained from electronic patient records and national databases. Follow-up continued until the end of 2014.ResultsCompared with patients with a single DKA admission, those with recurrent DKA (more than five episodes) were diagnosed with diabetes at an earlier age (median 14 [interquartile range 9–23] vs 24 [16–34] years, p < 0.001), had higher levels of social deprivation (p = 0.005) and higher HbA1c values (103 [89–108] vs 79 [66–96] mmol/mol; 11.6% [10.3–12.0%] vs 9.4% [8.2–10.9%], p < 0.001), and tended to be younger (25 [22–36] vs 31 [23–42] years, p = 0.079). Antidepressant use was greater in those with recurrent DKA compared with those with a single episode (47.5% vs 12.6%, p = 0.001). The inpatient DKA mortality rate was no greater than 0.16%. A single episode of DKA was associated with a 5.2% risk of death (4.1 [2.8–6.0] years of follow-up) compared with 23.4% in those with recurrent DKA admissions (2.4 [2.0–3.8] years of follow-up) (HR 6.18, p = 0.001).Conclusions/interpretationRecurrent DKA is associated with substantial mortality, particularly among young, socially disadvantaged adults with very high HbA1c levels.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-016-4034-0) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

Factors associated with mortality in children with diabetic ketoacidosis (DKA) in South India

Mortality in diabetic ketoacidosis (DKA) among children has been reported to be 0.3–3 % in developed countries. Based on the limited data from developing countries, the mortality reported is as high as 13.4 %. A prospective study was conducted to identify the factors leading to high mortality in children with DKA in South India. This was a study of 118 episodes of DKA among children, admitted in a pediatric tertiary care center at Chennai. Clinical presentation, laboratory parameters at admission, parameters during treatment, and complications were considered as risk factors. All children were followed up till discharge from hospital or death. Univariate and multivariate analyses for risk factors were undertaken. Altered sensorium and higher osmolality at admission, delayed diagnosis, cerebral edema, shock, renal failure, and sepsis were the major risk factors associated with mortality in multivariate analysis. Cerebral edema was encountered in 23.7 %, shock in 12.7 %, sepsis in 11 %, and renal failure in 9.3 %. The overall mortality rate was 11 %. Delayed diagnosis may be the root cause for high mortality in children with DKA in developing countries. There is an urgent need to create awareness among physicians, teachers, and parents to avoid a delay in diagnosis and decrease the mortality in children with DKA. Higher incidence of cerebral edema, shock, renal failure, and sepsis are unique problems identified in this study. There is a need for further studies on fluid management of shock, strategies for management of renal failure in DKA, and use of antibiotics in DKA in developing countries.

Delayed diagnosis of diabetic ketoacidosis in children—a cause for concern

Diabetic ketoacidosis (DKA) is the major cause for mortality in children with diabetes mellitus (DM). Delayed diagnosis or missed diagnosis is common among children with DKA. This study was undertaken to identify the impact of delayed diagnosis on clinical presentation, complications, and mortality of DKA in children from a tertiary care center at Chennai. Among the 118 episodes of DKA in 100 children less than 12 years of age, delayed diagnosis was more common in new onset diabetes mellitus (DM). Forty-four out of 68 children with new onset DM with DKA (64.7 %) had delayed diagnosis. Thirty-two children with established diabetes presented with 50 episodes of DKA. Among these, eight episodes (16 %) had a delay in diagnosis; 85.7 % of infants, 76.9 % of toddlers, and 58 % of the preschool and school children had delayed diagnosis. Urinary tract infections, respiratory illness, vomiting, febrile illness, acute abdomen, and encephalopathy were the common diagnosis in children where DKA was missed. The causes for delay in diagnosis and management of DKA were lack of parental and physician awareness, improper referral, and delayed transport. Presence of shock, altered sensorium, severe DKA, lower PaCO2 at admission, and complications like renal failure and cerebral edema were higher in children with delayed diagnosis of DKA. This was found to be statistically significant. Delayed diagnosis was a significant risk factor for mortality in children with DKA (p = 0.00) in this study population.

Risk factors for mortality in children with diabetic keto acidosis from developing countries.

Diabetic keto acidosis (DKA) is the major cause for mortality in children with Diabetes mellitus (DM). With increasing incidence of type 1 DM worldwide, there is an absolute increase of DM among children between 0-14 year age group and overall incidence among less than 30 years remain the same. This shift towards younger age group is more of concern especially in developing countries where mortality in DKA is alarmingly high. Prior to the era of insulin, DKA was associated with 100% mortality and subsequently mortality rates have come down and is now, 0.15%-0.31% in developed countries. However the scenario in developing countries like India, Pakistan, and Bangladesh are very different and mortality is still high in children with DKA. Prospective studies on DKA in children are lacking in developing countries. Literature on DKA related mortality are based on retrospective studies and are very recent from countries like India, Pakistan and Bangladesh. There exists an urgent need to understand the differences between developed and developing countries with respect to mortality rates and factors associated with increased mortality in children with DKA. Higher mortality rates, increased incidence of cerebral edema, sepsis, shock and renal failure have been identified among DKA in children from developing countries. Root cause for all these complications and increased mortality in DKA could be delayed diagnosis in children from developing countries. This necessitates creating awareness among parents, public and physicians by health education to identify symptoms of DM/DKA in children, in order to decrease mortality in DKA. Based on past experience in Parma, Italy it is possible to prevent occurrence of DKA both in new onset DM and in children with established DM, by simple interventions to increase awareness among public and physicians.

Decreased Morbidity and Mortality in DKA Over Time

Research Article| December 01 2013 Decreased Morbidity and Mortality in DKA Over Time AAP Grand Rounds (2013) 30 (6): 70. https://doi.org/10.1542/gr.30-6-70 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Decreased Morbidity and Mortality in DKA Over Time. AAP Grand Rounds December 2013; 30 (6): 70. https://doi.org/10.1542/gr.30-6-70 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: diabetic ketoacidosis Source: White PC, Dickson BA. Low morbidity and mortality in children with diabetic ketoacidosis treated with isotonic fluids. J Pediatr. 2013; 163(3): 761– 766; doi: https://doi.org/10.1016/j.jpeds.2013.02.005Google Scholar Investigators from the University of Texas Southwestern conducted a retrospective study to assess the rate of cerebral edema (CE) in children with diabetic ketoacidosis (DKA) treated with a specific protocol. A major feature of the protocol was use of a “two bag method” of intravenous (IV) fluid administration (both bags contained isotonic electrolyte concentrations, and one included 10% dextrose), allowing rapid bedside adjustment of glucose infusion rate. Fluid administration typically ranged from 2 to 2.5 times maintenance rates. Administrative databases and medical records were queried to identify children hospitalized with DKA at a single institution between 1999 and 2011. Clinical and demographic data of study children were abstracted from the medical records. The presence of CE was defined either by a positive CT scan or documented treatment for altered mental status other than routine DKA management. Clinical features of children with and without CE were compared. The investigators also measured the rate of death in admissions for DKA and/or neurologic sequelae at discharge. To assess compliance with the standard protocol, the investigators reviewed randomly selected medical records of 100 admissions in children with DKA; 66 admissions were managed in accordance with the protocol. Data were analyzed on 3,712 admissions for DKA in 2,436 unique patients. Three hundred forty-eight admissions were treated in the ICU and 229 had a head CT. Twenty admissions met the study definition of CE (0.5%). Children with CE had significantly worse acidosis (median pH 7.07 vs 7.25) and more severe hyperglycemia (median initial glucose 530 vs 339 mg/dL) than those without this complication. CE was significantly associated with multiple admissions in the same patient for DKA. One study patient (without CE) died, and neurologic sequelae were reported in 2 patients (one of whom had CE), for an overall death or disability rate of 0.08%. The authors conclude that, compared with recently reported data in children with DKA (death or disability in 0.3%1 ), use of the DKA protocol used at their institution is associated with extremely low rates of morbidity and mortality. Dr Sweney has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. DKA continues to complicate care of children with type 1 diabetes. Risk factors for DKA include: teen years, female gender, low economic status, insulin pump malfunction, poor glycemic control, and a concurrent psychiatric disorder.2 CE is the most serious complication, and clinically apparent CE complicates up to 1% of DKA admissions. Serial imaging studies suggest that the majority of children have smaller ventricular spaces or “subclinical” brain edema3 during the acute illness as compared to their baseline, but the mechanism by which subclinical brain swelling changes to clinical brain swelling remains uncertain. Unfortunately, those with clinical signs of... You do not currently have access to this content.

Diabetic keto acidosis—among children with established diabetes from a pediatric tertiary care Institute

A prospective observational study was undertaken from a pediatric tertiary care Institute at Chennai, among the diabetic keto acidosis (DKA) episodes in children with established diabetes mellitus (DM) and DKA in new onset DM between Jun 2009 and Jan 2012. Clinical and laboratory parameters, predisposing factors, complications and the outcome were compared between the two groups. Among the 97 episodes of DKA treated during the study period 42(43.3 %) were among the known diabetic children. Overall 32 children accounted for 42 episodes of DKA. Female preponderance was encountered among DKA episodes in children with established diabetes. All children with 2 or more episodes of DKA were females. Precipitating factors were infections in 47 % and poor compliance to therapy in 28 % . Difficult or unstable family circumstances were encountered in 40 % of children. Female preponderance (P-0.001), severe DKA(P-0.003), shorter duration of illness(P-0.009), skin infections (P-0.028) and higher insulin requirement (P-0.003) showed a statistically significant difference in DKA among children with established DM in comparison to DKA among new onset DM. The metabolic parameters and complications were almost similar to newly diagnosed diabetic children. Mortality in DKA among established diabetic children is 7.1 % in comparison to 12.7 % in new onset DKA.