Severe Diabetic Ketoacidosis Research Articles

Analysis of complications related to diabetic ketoacidosis in pediatric patients at a University Hospital: a cross-sectional study.

Diabetic ketoacidosis is one of the main complications of type 1 diabetes mellitus and the leading cause of death among children and adolescents with the disease. The objective of this study was to characterize the cases of diabetic ketoacidosis treated in a University Hospital reference in pediatric endocrinology and identify their most frequent complications. A cross-sectional descriptive study was carried out, based on the review of medical records of patients aged 0-16 years with a diagnosis of diabetic ketoacidosis treated between January 2016 and August 2020. Insulin therapy was performed subcutaneously as part of the hospital's protocol. Seventy-seven (77) admissions were analyzed and 55.8 % were diagnosed with a new case of type 1 diabetes. Adolescents (54.5 %) were the most affected. An increase of 90.9 % of cases between 2016 and 2020 was visualized. Severe DKA was more frequent in school-aged children. An increase in the dose of insulin was related to the severity of diabetic ketoacidosis. Hypokalemia was the most frequent complication. Cerebral edema occurred in 11.7 % of cases, and it was the cause of the only death, corresponding to a mortality rate of 1.3 %. Rising DKA incidence aligns with global trends, with poor adherence driving cases in previously diagnosed adolescents. High rates of hypokalemia and cerebral edema were found, but with lower mortality, showing the effectiveness of subcutaneous insulin for treatment. Future studies should confirm findings, address adherence issues, and refine hydration, insulin dosing, and monitoring practices to reduce complications.

Buffered salt solution versus 0.9% sodium chloride as fluid therapy for patients presenting with moderate to severe diabetic ketoacidosis: Study protocol for a Phase-3 cluster-crossover, blinded, randomised, controlled trial

Buffered salt solution versus 0.9% sodium chloride as fluid therapy for patients presenting with moderate to severe diabetic ketoacidosis: Study protocol for a Phase-3 cluster-crossover, blinded, randomised, controlled trial

Association of Diabetic Ketoacidosis at Onset, Diabetes Technology Uptake, and Clinical Outcomes After 1 and 2 Years of Follow-up: A Collaborative Analysis of Pediatric Registries Involving 9,269 Children With Type 1 Diabetes From Nine Countries.

This study examined the association between diabetic ketoacidosis (DKA) at type 1 diabetes diagnosis and long-term glycemic outcomes, insulin requirements, BMI SDS, and diabetes technology uptake in youth. Data were from nine countries (Austria, Czechia, Germany, Italy, Luxembourg, New Zealand, Slovenia, Switzerland, and U.S. [Colorado]), including youth (0.5-15.9 years) diagnosed with type 1 diabetes in 2019-2020 and followed for 2 years thereafter. Participants were divided into three groups: no DKA, nonsevere, and severe DKA at diagnosis. HbA1c, insulin requirements, BMI SDS, and use of technology, including automated insulin delivery (AID), were assessed. The analysis included 9,269 individuals (54.8% males, mean age 9.0 years). DKA at diagnosis was observed in 34.2% of participants and severe DKA in 12.8%. After 1 year, adjusted mean HbA1c was higher in the severe DKA group (7.41%) compared with nonsevere DKA (7.23%, P = 0.001) and no DKA groups (7.14, P < 0.001), and this difference persisted after 2 years (7.58% vs. 7.38% [P < 0.001] and vs. 7.32% [P < 0.001]). Higher BMI SDS was observed in both DKA groups compared with no DKA. The use of AID was associated with lower HbA1c levels compared with other treatment modalities and moderated differences between DKA groups after 2 years of follow-up (P = 0.072). Severe and nonsevere DKA at type 1 diabetes diagnosis were both associated with persistently higher HbA1c and higher BMI SDS. AID use diminishes the association of DKA at diagnosis and higher HbA1c over time.

Relationship Between Inflammatory Markers (IL-6, Neutrophil-Lymphocyte Ratio, and C-Reactive Protein-Albumin Ratio) and Diabetic Ketoacidosis Severity: Correlation with Clinical Outcomes.

Background and Objectives: The use of additional biomarkers to predict clinical course in diabetic ketoacidosis (DKA) is becoming increasingly important. The aim of this study was to investigate the relationship between interleukin-6 (IL-6) levels and the length of stay in the intensive care unit (ICU) in patients with DKA without signs of infection and to investigate the relationship between the neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP) albumin ratio (CAR). Materials and Methods: This retrospective, single-center study included 78 patients with DKA without infection who were treated in the Medical ICU between July 2022 and June 2024. The patients were divided into two groups: moderate DKA (Group 1) and severe DKA (Group 2). The patients' IL-6 levels, peripheral blood inflammatory markers (CAR, NLR), Acute Physiology and Chronic Health Evaluation (APACHE) II scores, and the duration of ICU stay were recorded. Results: The median duration of stay in the ICU was 2.00 (1-6) days in group 1 and 3.00 (1-26) days in group 2 (p = 0.001). The mean pH, HCO3, and CO2 values in Group 1 were 7.20 ± 0.07, 13.58 ± 2.11 mEq/L, and 29.45 ± 6.27 mmHg, while the mean pH, HCO3, and PCO2 values in Group 2 were 7.01 ± 0.11, 7.11 ± 1.91 mEq/L, and 20.35 ± 4.91 mmHg (p < 0.001, p < 0.001, p < 0.001, respectively). There was a strong positive correlation between IL-6 levels and the length of stay in the ICU (r = 0.813, p < 0.001). Additionally, there was a moderate positive correlation between the length of stay in the ICU with the severity of DKA (r = 0.475, p < 0.001), CAR (r = 0.336, p < 0.001), and NLR (r = 0.562, p < 0.001). Conclusions: Inflammatory markers such as NLR and CAR, and more specifically IL-6, were found to be associated with the clinical course and duration of stay in the ICU in patients with DKA.

The impact of the COVID-19 pandemic on DKA severity in Black and White pediatric patients.

Diabetic ketoacidosis (DKA) is a complication of uncontrolled diabetes mellitus, with a known increase in severity and incidence during the COVID-19 pandemic. Our institution also observed a rise in pediatric DKA cases in our largely underserved patient population. We hypothesized that the impact would be more pronounced in Black patients due to prepandemic healthcare inequities. To investigate this, we confirmed the increased number of severe DKA cases in our pediatric patients during the pandemic and then stratified data to compare laboratory values between Black and White patients. We analyzed patients with a DKA diagnosis admitted to our institution's pediatric intensive care unit (PICU) prior to the pandemic (March 2016 to December 2017) and during its peak (March 2020 to December 2021). Our data demonstrated more cases of severe DKA overall during 2020-2021 and when compared to prepandemic years, a statistically significant increase in severity for Black, but not White patients.

Safety and Effectiveness of MiniMed™ 780G Advanced Hybrid Closed-Loop Insulin Intensification in Adults with Insulin-Requiring Type 2 Diabetes.

Background: Early feasibility studies have demonstrated safe and effective automated insulin delivery use in individuals with suboptimally controlled type 2 diabetes (T2D). The present study investigated MiniMed™ 780G advanced hybrid closed-loop (AHCL) therapy safety and effectiveness in adults with insulin-requiring T2D. Materials and Methods: This 13-site, single-arm, open-label study included 95 adults (mean ± standard deviation [SD] age of 60.3 ± 10.8 years and T2D duration of 18.6 ± 8.6 years) using basal-bolus insulin therapy. Participants underwent a run-in period (∼21 days) of open-loop or HCL followed by a study period (∼90 days) of AHCL. The primary safety end point was mean change in glycosylated hemoglobin (HbA1c) from baseline to the end of the 3-month study period. The primary and secondary effectiveness end points were noninferiority and superiority in the percentage of time in range (%TIR 70-180 mg/dL) during the last 6 weeks of the study period (computed by the Hodges-Lehmann method). Safety metrics, including the rates of severe hypoglycemia, diabetic ketoacidosis (DKA), and hyperosmolar hyperglycemic state (HHS), were summarized. Results: HbA1c was reduced from 7.9% ± 1.0% (62.4 ± 10.4 mmol/mol) at baseline to 7.2 ± 0.7% (54.7 ± 8.0 mmol/mol) (P < 0.001). The %TIR estimate was 80.9% (95% confidence interval: 78.4%, 83.1%), and the significance criteria for both the primary and secondary effectiveness end points were met (P < 0.001). While total daily insulin dose was increased from run-in to the end of the study (77.4 ± 38.5 U vs. 91.8 ± 49.3 U, P < 0.0001), announced carbohydrates were unchanged, and the number of daily user-initiated boluses was reduced (3.9 ± 1.9 vs. 3.2 ± 1.8, P < 0.0001). There was no significant change in participant weight or body mass index, no severe hypoglycemia, DKA, or HHS, and no serious or unanticipated adverse device effects. Conclusions: These findings show that MiniMed 780G AHCL use provides safe insulin intensification in type 2 diabetes and significantly improves mean HbA1c and %TIR.

Hybrid closed-loop insulin therapy and risk of severe hypoglycaemia and diabetic ketoacidosis in young people (aged 2-20 years) with type 1 diabetes: a population-based study.

Hybrid closed-loop insulin therapy and risk of severe hypoglycaemia and diabetic ketoacidosis in young people (aged 2-20 years) with type 1 diabetes: a population-based study.

Unraveling the Mystery: COVID-19 and Diabetic Complications - A Journey from Pathophysiology to Treatment.

The connection between COVID-19 and DM unveils a multifaceted interplay that significantly impacts disease severity and management strategies. Initial studies reveal that people with DM had higher severity rates of COVID-19 due to the infection by SARS-CoV-2. The virus solely induces hyperglycemia and, at the same time, profoundly influences the immune and inflammatory reactions, increasing the rate of severe complications and death among diabetes patients. Therefore, understanding the underlying mechanisms behind this interplay is critical for effective treatment. Furthermore, COVID-19 also brings new factors to the equation of managing diabetes. Although the virus thoroughly relies on the ACE2 receptor for viral entry, DPP4 is a substitute receptor. However, glucose-lowering DPP4 inhibitors provide only a minor association with COVID-19 vulnerability. Also, the SGLT2 inhibitors are contraindicated in certain conditions with COVID-19, and hence, insulin is generally recommended as a first-line treatment for acute glycemic control in hospitalized or critically ill COVID-19 patients, particularly those with severe hyperglycemia or diabetic ketoacidosis. COVID-19-associated aggravating factors, such as cardiovascular disease, chronic kidney disease, and neuropathy, predispose people with diabetes to severe conditions. Thus, it is important to explore this speculation, and the present review aims to understand this complex interaction during patient care models and specify the therapeutic approaches to address this problematic convergence of two substantial health concerns.

Lymphocyte-C-reactive protein ratio upon admission to predict disease progression and ICU admission in adult patients with diabetic ketoacidosis

This study aimed to investigate whether lymphocyte-C-reactive protein ratio (LCR) upon admission can predict disease progression and intensive care unit (ICU) admission in adult patients with diabetic ketoacidosis (DKA). A single-center retrospective study was conducted, including adult DKA patients admitted to the First Affiliated Hospital of Harbin Medical University between March 2018 and March 2023. Multiple demographic and clinical data were collected from the medical records upon admission and during hospitalization. Subsequently, sequential organ failure assessment (SOFA) score and LCR were calculated based on relevant clinical parameters within 24 h of admission. These indicators were compared among different disease severity groups, and factors related to severe DKA, concurrent acute kidney injury (AKI), and ICU admission were further analyzed. Receiver operating characteristic (ROC) curve analysis was performed to determine the sensitivity, specificity, area under the ROC curve (AUC), and cut-off value of LCR. A total of 271 adult DKA patients were enrolled and categorized into three groups: mild group (n = 42), moderate group (n = 64), and severe group (n = 165). Significant differences in demographic and clinical data were observed among these groups. Glasgow coma scale (GCS) score, LCR, pH, and bicarbonate (HCO3-) were identified as protective factors for severe DKA. Conversely, SOFA score, neutrophil count (NEUT), serum creatinine (SCr), and glucose (GLU) were risk factors for concurrent AKI. Concurrent AKI and SOFA score were risk factors for ICU admission, while pH was a protective factor. The areas under the ROC curve (AUC) of LCR to classify adult DKA patients into mild group, severe group, and ICU admission were 0.679, 0.718, and 0.621, respectively, with cut-off value of 212.80, 96.16, and 63.35, sensitivity of 54.8%, 76.4%, and 78.9%, and specificity of 76.0%, 62.4%, and 46.3%. LCR upon admission provides great potential to predict disease progression and ICU admission in adult patients with DKA.

Severe Diabetic Ketoacidosis in Children with Type 1 Diabetes: Ongoing Challenges in Care.

Diabetic ketoacidosis is the most common acute complication in children and adolescents with type 1 diabetes, and contributes significantly to morbidity, mortality, and healthcare burden. This review aims to explore the multifaceted aspects of severe diabetic ketoacidosis in pediatric age, including its epidemiology, pathogenesis, risk factors, complications and emphasizing advances in prevention strategies. Incidence rates vary due to influences from geographic, socioeconomic, cultural and demographic factors. Pathogenesis is linked to insulin deficiency and an excess of counter-regulatory hormones, which disrupt glucose, protein, and lipid metabolism, causing hyperglycemia, ketosis, acidosis, dehydration, and electrolyte imbalances. According to the International Society for Pediatric and Adolescent Diabetes guidelines, severe diabetic ketoacidosis is characterized by a pH < 7.1 or bicarbonate < 5 mmol/L. This condition can lead to a wide range of life-threatening complications, including cerebral edema that represents the leading cause of death. Several prevention strategies, including awareness campaigns, early diagnosis of diabetes, regular monitoring and management, effective insulin therapy, education, access to healthcare and technological assistance, may contribute to reduce the risk of severe diabetic ketoacidosis episodes in children and adolescents.

Differential expression of plasma proteins and pathway enrichments in pediatric diabetic ketoacidosis

BackgroundIn children with type 1 diabetes (T1D), diabetic ketoacidosis (DKA) triggers a significant inflammatory response; however, the specific effector proteins and signaling pathways involved remain largely unexplored. This pediatric case–control study utilized plasma proteomics to explore protein alterations associated with severe DKA and to identify signaling pathways that associate with clinical variables.MethodsWe conducted a proteome analysis of plasma samples from 17 matched pairs of pediatric patients with T1D; one cohort with severe DKA and another with insulin-controlled diabetes. Proximity extension assays were used to quantify 3072 plasma proteins. Data analysis was performed using multivariate statistics, machine learning, and bioinformatics.ResultsThis study identified 214 differentially expressed proteins (162 upregulated, 52 downregulated; adj P < 0.05 and a fold change > 2), reflecting cellular dysfunction and metabolic stress in severe DKA. We characterized protein expression across various organ systems and cell types, with notable alterations observed in white blood cells. Elevated inflammatory pathways suggest an enhanced inflammatory response, which may contribute to the complications of severe DKA. Additionally, upregulated pathways related to hormone signaling and nitrogen metabolism were identified, consistent with increased hormone release and associated metabolic processes, such as glycogenolysis and lipolysis. Changes in lipid and fatty acid metabolism were also observed, aligning with the lipolysis and ketosis characteristic of severe DKA. Finally, several signaling pathways were associated with clinical biochemical variables.ConclusionsOur findings highlight differentially expressed plasma proteins and enriched signaling pathways that were associated with clinical features, offering insights into the pathophysiology of severe DKA.

Real world efficacy and safety of the advanced hybrid closed-loop system MiniMed 780G (SmartGuard) in children under 7 years of age.

To evaluate the safety and efficacy of the Medtronic 780G SmartGuard™ AID system in children under 7 years of age with type 1 diabetes (T1D). Retrospective analysis of data from children living with T1D under 7 years of age using the MiniMed 780G™ across three pediatric endocrinology units in the Canary Islands. Metabolic control parameters were analyzed from 14 days of pretreatment to 12 months of follow-up. The study included 61 children under 7 years of age, 35 in Group 1 and 26 in Group 2. In Group 1, there was a significant increase in time in range (TIR) (13%, p = 0,000), along with a significant decrease in time above range (TAR) (7% for TAR1 and 3% for TAR2; p = 0,000). These improvements persisted for up to 1 year of follow-up. In Group 2, there was a significant increase in the TIR (7%; p = 0,000) and a significant decrease in the TAR (7%; p = 0,000 for TAR1 and 6.5%; p = 0,001 for TAR2). These improvements persisted for up to 6.5 months of follow-up. No significant changes were observed in the time below range (TBR) or variation coefficient (CV) in either group. No events of severe hypoglycemia or diabetic ketoacidosis occurred. Efficacy and safety were maintained in children with a TDD <8 units/day. The use of the Medtronic 780G™ SmartGuard™ system in children under 7 years of age with T1D is effective and safe, with benefits persisting for up to 6-12 months. The safety profile is maintained in children receiving a TDD <8 units/day.

Altered association between cortisol and adrenocorticotropic hormone levels in the early stage of type 2 diabetic ketoacidosis.

In the early stages of various critical infections and diseases, altered association of cortisol and adrenocorticotropic hormone (ACTH) levels occurs, with cortisol levels increasing and ACTH levels remaining normal or decreasing. This study aimed to explore the relationship between ACTH and cortisol levels in patients with diabetic ketoacidosis (DKA) and the influence of the severity of DKA. A total of 106 type 2 diabetes patients with DKA admitted to the Endocrinology Department of Yantai Yuhuangding Hospital from February 2018 to May 2023 were divided into groups without (n=54) and with bacterial infection (n=52). Twenty type 2 diabetes patients without infection or DKA admitted during the same period were included as the control group. Cortisol and ACTH levels were measured on the first day of admission and the day after DKA correction for patients with DKA and on the first day of admission and the day before discharge for the control group. Compared with the control group, the DKA groups both with and without infection had significantly higher cortisol levels (P<0.05) and significantly lower ACTH levels (P<0.01) at admission. DKA patients with infection had significantly higher cortisol levels at admission than those without infection (734.51 ± 348.69 nmol/L vs 508.79 ± 268.72 nmol/L, P<0.01), while ACTH levels did not differ significantly between the two groups (P>0.05). After correction of DKA, no differences in cortisol or ACTH levels were observed among the three groups. Compared with levels at admission, DKA patients both with and without infection had lower cortisol levels and higher ACTH levels after DKA correction (all P<0.001). Multiple stepwise regression analysis showed that for all DKA patients and for subgroups with and without infection, the cortisol level at admission was independently positively correlated with the ACTH level and negatively correlated with the bicarbonate level (both P<0.01). In the early stage of DKA, a phenomenon of altered association between cortisol-ACTH occurs and is especially prominent in DKA patients with infection. This altered association between cortisol-ACTH disappears after DKA correction, and the severity of DKA is an independent influencing factor on the cortisol level in early-stage DKA.

Vitamin D deficiency is common among Polish children with newly diagnosed type 1 diabetes mellitus.

In recent years, the prevalence of T1DM (type 1 diabetes mellitus) and other autoimmune diseases in the paediatric population has been increasing. The aim of this study was to evaluate vitamin D levels among children with newly diagnosed T1DM, taking into account the most common coexisting autoimmune conditions. The database included 361 patients diagnosed with T1DM between 2020 and 2021, with a mean age of 9.27 ± 4.1 years, 189 boys. Auxological data and biochemical results of routinely performed tests were retrospectively analysed: blood pH and bicarbonate (HCO3-) on gasometry on admission, glycated haemoglobin (HbA1c), levels of antibodies against glutamic acid decarboxylase (GAD), antibodies against tyrosine phosphatase (IA2), antibodies against zinc transporters (ZnT8), 25-hydroxy vitamin D (25(OH)D), anti-IgA tissue transglutaminase antibodies (TTG-IgA), total IgA, levels of antibodies against thyroperoxidase (TPOAb), and antibodies against thyroglobulin (TgAb). 35.5% of children (n = 128) with T1D presented 25(OH)D deficiency (< 20 ng/mL), 37% (n = 134) had suboptimal levels (20-30 ng/mL), and 25% (n = 90) had optimal vitamin D levels (30-50 ng/mL). 25(OH)D values were inversely proportional to the severity of diabetic ketoacidosis (p < 0.01) and negatively correlated with HbA1c values (p < 0.05). 25(OH)D levels were also found to be negatively correlated with children's age at diagnosis (p < 0.001). Statistical analysis showed no association between 25(OH)D value and body mass index (BMI) Z-score or type of antibodies typical of T1D. There was also no statistically significant difference in vitamin D levels among patients with additional autoimmune processes (antibodies to thyroperoxidase and/or thyroglobulin and antibodies to tissue transglutaminase). More than one-third of Polish children with newly diagnosed T1D have 25(OH)D deficiency, especially in patients with diabetic ketoacidosis (DKA) at the diagnosis of diabetes. Determination of vitamin D levels should be a routine procedure in children with newly diagnosed T1DM.

Association between Corrected QT Interval, QT Dispersion and Clinico-biochemical Severity of Diabetic Ketoacidosis in Children Aged 1-12 Years: A Prospective Cohort Study

Introduction: Diabetic Ketoacidosis (DKA) is a serious complication in children with type 1 diabetes, characterised by hyperglycaemia, metabolic acidosis and ketosis. It often leads to cardiac arrhythmias due to electrolyte imbalances and prolonged corrected QT interval (QTc). Aim: To investigate the frequency of QTc prolongation and QT dispersion (QTd) in paediatric DKA patients and their relationship with serum electrolytes and pH. Materials and Methods: A prospective cohort study was conducted over a one-year period (August 2022 to August 2023) in the paediatric Intensive Care Unit (ICU) of the Institute of Child Health and Hospital for Children, Egmore, Chennai, Tamil Nadu, India. The study included 150 children aged 1 to 12 years diagnosed with DKA. Electrocardiograms (ECGs) were recorded both at presentation and after recovery from DKA, with QTc and QTd evaluated using a 12-lead ECG. The Mann-Whitney U test was employed to compare medians and Interquartile Ranges (IQR) between two groups, while Spearman’s correlation coefficient was used to assess relationships between variables, with results illustrated through a scatter plot. A p-value &lt;0.05 was considered statistically significant. Results: Significant correlations were found between prolonged QTc intervals and severe acidosis, with affected patients exhibiting lower bicarbonate levels and higher anion gaps and blood ketone levels. After treatment, both QTc intervals and QTd significantly decreased, indicating improved cardiac repolarisation. Strong positive correlations were noted between QTc intervals and both the anion gap and blood ketone levels. Conclusion: The study highlights the QTc prolongation and QTd in children with DKA, which are closely linked to metabolic derangements. Routine ECG monitoring is essential for the early detection of QT prolongation, aiding in the prevention of life-threatening arrhythmias and improving patient outcomes.

An association study of serum calcium as a predictor of severity and prognosis in diabetic ketoacidosis in a tertiary care hospital

Background and objectives. Diabetic ketoacidosis (DKA) is a severe complication of diabetes mellitus characterized by metabolic acidosis and elevated ketone levels. While serum calcium levels have been studied in various medical contexts, their significance in assessing the severity and prognosis of DKA remains insufficiently examined. This study aims to explore the relationship between serum calcium levels and the clinical outcomes of DKA patients in a tertiary care setting. Materials and methods. We conducted a retrospective cohort study involving 20 patients hospitalized with DKA. Clinical data and laboratory results, including initial serum calcium concentrations, were gathered for analysis. Patients were categorized based on their serum calcium levels, and the relationship between these levels and clinical outcomes, severity indicators, and duration of hospital stay was evaluated. Outcomes. The primary results reveal a notable association between admission serum calcium levels and the severity of DKA. Patients with lower initial calcium levels experienced more complications, extended hospital stays, and higher severity indicators. Additionally, the study suggests potential links between serum calcium and important factors related to DKA severity. Conclusion. This research highlights the possible role of serum calcium as a predictor of severity and prognosis in DKA. Recognizing the connection between serum calcium levels and clinical outcomes may enhance risk assessment, facilitate early interventions, and support customized management approaches. Further prospective studies are necessary to confirm these findings and investigate the underlying mechanisms at play.

Can Mean Platelet Volume be an Inflammatory Marker in Pediatric Diabetic Ketoacidosis?

This study explores the association between mean platelet volume (MPV) and other hematological parameters in children with diabetic ketoacidosis (DKA), aiming to identify hematological changes and their implications for management and treatment strategies in pediatric type 1 diabetes mellitus (T1DM). In a retrospective, two-center analysis of 323 children, participants were categorized into three groups: DKA, T1DM without ketoacidosis, and healthy controls (95). Hematological parameters and HbA1c levels were collected. Blood pH levels classified DKA severity, and statistical analyses included One-way ANOVA, correlation tests, receiver operating characteristic curve analysis, and logistic regression to assess the predictive value of hematological parameters for DKA. No significant demographic differences were noted among the groups. Patients with DKA exhibited significantly lower MPV and higher neutrophil-to-lymphocyte ratio (NLR) compared with both patients with T1DM without ketoacidosis and healthy controls. Logistic regression showed MPV ≤9.35 and NLR ≥2.73 significantly increased DKA risk. This study demonstrated a significant relationship between DKA and altered hematological parameters (MPV and NLR) in pediatric patients, highlighting their potential as markers for early detection and risk assessment of DKA.

Acute Kidney Injury in Children with Diabetic Ketoacidosis

Backgrounds and Objectives: Diabetic ketoacidosis is frequent in type I diabetic children, and as acute kidney injury has a well-known morbidity, this study aims to determine the frequency and associated factors of acute kidney injury in these children. Material and Methods: A prospective study conducted on type I diabetic children with diabetic ketoacidosis admitted at Central Child Teaching Hospital; during February 2020 - January 2021. The study includes 96 patients, aged &lt; 15 years. Demographic and clinical information collected for each patient, including ( age, gender, onset of diabetes, previous diabetic ketoacidosis, recurrent urinary tract infection). At admission all patients underwent clinical assessment of their heart rate and amount of resuscitation boluses given; and weight and height measured. PH and HCO3 levels used to categorize diabetic ketoacidosis severity. Kidney Disease Improving Global Outcomes S.creatinine criteria used to identify acute kidney injury. Estimated basal creatinine using modified Schwartz formula, with glomerular filtration rate 120 ml/min/m2 was used. Logistic regression analysis used to identify risk factors. Results: A total 19 (19.8%) participants developed acute kidney injury(AKI) at 24hrs hospitalization [ 15 (78.9%) cases AKI stage I, 2 (10.5%)cases AKI stage II, and 2 (10.5%)cases AKI stage III ]. One child required peritoneal dialysis at second day of admission. Diabetic ketoacidosis severity odds for AKI reached 5.5 and increased to 13.3 with increasing heart rate. Conclusions: Acute kidney injury occurred in one in five of children during diabetic ketoacidosis with ketoacidosis severity and high heart rate at admission is an important associated factors.

Factors Associated With the Severity of Diabetic Ketoacidosis on Admission in Pediatric Intensive Care: A Retrospective Study.

Background Diabetic ketoacidosis (DKA) is one of the leading causes of morbidity and mortality in children with diabetes, often requiring intensive care unit management. This study aimed to identify factors associated with the severity of DKA in infants and children hospitalized in pediatric intensive care. Methodology This retrospective, monocentric, descriptive, analytical study included infants and children aged one month to 17 years who presented with DKA meeting the International Society for Pediatric and Adolescent Diabetes 2022 criteria. The study was conducted at the Pediatric Intensive Care Unit of the International University Hospital Cheikh Khalifa in Casablanca from July 2018 to February 2023. For data analysis, patients were divided into two groups, namely, severe DKA and non-severe DKA. Data analysis was performed using Jamovi software. Results Of the 63 children included, 26 (41.3%) had severe DKA, and 37 (58.7%) had non-severe DKA. The mean age was 8.92 ± 5.18 years, with a sex ratio of 0.97. Statistical analysis revealed a significant clinical difference between DKA severity and the presence of dyspnea at admission (p = 0.004) and drowsiness (p = 0.003). Regarding biological parameters, the study showed that patients with severe DKA had significantly higher white blood cell (WBC) counts (p = 0.013), as well as significantly higher procalcitonin (PCT) levels (p = 0.038) and C-reactive protein (CRP) concentrations (p = 0.011) compared to children admitted with non-severe DKA. No significant differences were observed between the two groups regarding age, sex, symptoms, triggering factors, or clinical outcomes. Conclusions The severity of DKA in children is associated with the presence of neurological disturbances and dyspnea at admission, as well as a significant elevation in WBC count, CRP, and PCT.

Comparison of pediatric diabetic ketoacidosis in newly diagnosed versus known patients with type 1 diabetes mellitus: A single-center study.

To compare the demographic, clinical, and biochemical characteristics of newly diagnosed versus known patients with type 1 diabetes mellitus (T1DM) presenting with diabetic ketoacidosis (DKA) in a tertiary care center in the Western region of Saudi Arabia. We retrospectively reviewed 147 children and adolescents diagnosed with T1DM who presented with DKAs between January 2019 and December 2023. Data on age, gender, nationality, economic status, episode severity, presenting symptoms, and biochemical markers were collected and analyzed. The mean patient age was 7.24 years, with known patients being older (mean age: 8.24 years) than newly diagnosed patients (mean age: 6.34 years). Most patients (55.8%) belonged to the middle-childhood age group (6 to 11 years). Among known patients, the most prevalent symptoms included vomiting, reported by 62 (88.6%) individuals, and abdominal pain, which affected 55 (78.6%). In contrast, new patients exhibited a strikingly high incidence of polyuria, with 68 (88.3%) cases, and polydipsia, affecting 65 (84.4%) individuals. The DKA incidence was higher in newly diagnosed patients, particularly in the middle-childhood age group. Economic factors may contribute to disease manifestations, and newly diagnosed patients had longer DKA symptom durations. The higher DKA incidence and severity in newly diagnosed patients, particularly in certain age groups, underscores the importance of increased disease awareness and early diagnosis.