Study of risk factors and outcome in children with diabetic ketoacidosis

Background: Diabetic ketoacidosis (DKA) has a high morbidity and mortality in type 1 diabetes mellitus (TIDM). Identifying the risk factors and the outcome in children with DKA will help in better awareness among parents and lead to early diagnosis thus preventing the complications of DKA.
Objectives: To assess the demographic and clinical characteristics and risk factors of DKA and the factors affecting the outcome of DKA.
Method: This hospital based prospective study was conducted in the paediatric emergency and intensive care department from February 2021 to July 2022. Duration of intensive care unit stay, insulin infusion, hospital stay, time for resolution of acidosis and outcome were taken into account and data were analysed.
Results: There were 48 children with 33% boys and 66.7% girls; 62.5% were new cases. Among old cases, 16.2 % were diagnosed for >2 years with preceding HbA1c >9.0%. The commonest clinical presentation was nausea and vomiting (91.7%). Prerenal acute kidney injury (AKI) was present in 43.8% at admission. Severe hyponatraemia was seen in 62.5% with the probability of going on to cerebral oedema. Culture positive sepsis was seen in 12% of children with DKA. AKI developed around 5-7 days of hospital stay in 50% cases requiring peritoneal dialysis. Mortality rate was 8.3%.
Conclusions: DKA was more prevalent in adolescent children and newly diagnosed TIDM cases. Severe acidosis and persistent electrolyte disturbances even after 24-48 hours of standard treatment protocol predicted the severity of disease and its untoward outcome