Diabetic Ketoacidosis: Demographic Data, Clinical Profile and Outcome in a Tertiary Care Hospital

Background: Diabetic ketoacidosis (DKA) is an acute and life-threatening situation that accounts for the majority of diabetes-related morbidity and mortality in children and adolescents who suffer from type 1 diabetes mellitus (T1DM). Objectives: To investigate the demographic, clinical characteristics, and outcomes of DKA in young patients with established T1DM and newly diagnosed diabetes in a tertiary referral hospital. Methods: Data from all T1DM patients diagnosed with DKA episodes in the pediatric endocrine unit at Besat university hospital, Hameden, Iran during 2006 - 2013 were reviewed in a retrospective study. The data collected includes the demographic data (age, sex, place of residence, first presentation and established T1DM), clinical presentation (main presenting symptoms, average duration of presenting symptoms before hospitalization, precipitating factors, severity of DKA, level of consciousness), laboratory parameters (blood sugar, arterial blood gases, urine ketones, serum electrolytes) and the outcome. DKA was defined as a glucose level higher than 250 mg/dL, pH < 7.30, bicarbonate > 15 mmol/L and ketonuria. Data was entered and analyzed on SPSS version 16. A P value less than 0.05 were defined as statistically significant. Results: The study population comprised 72 children satisfying the inclusion criteria of the study. Mean age of patients was 9.4 ± 4.08 years (range 5 months-18.2 years). The majority (61.1%) of patients were urban residents. DKA occurrence was higher (29.2%) in summer. Newly diagnosed diabetics accounted for 59 (81.9%) of the patients. The majority of the patients (54.2%) were aged 10 - 14 years. The median duration of symptoms before the hospitalization was 9.5 ± 9 days. The most commonly reported presenting symptoms were polyuria (86.1%), polydipsia (84.7%) followed by gastrointestinal symptoms. Nearly 40.2% of patients presented with an altered level of consciousness. About half of patients had a medical encounter before diagnosis. The mean initial blood glucose was 423 ± 96 mg/dL. Severe DKA was occurring more frequently than moderate and mild forms (47.2%, versus 34.7% and 18.1%, respectively). DKA was significantly more severe in girls (P = 0.004). Average time of recovery was 21 hours (range 4 - 75 h). The commonest complication was hypokalemia (34.7%) followed by hypernatremia (26.4%). There was a significant relationship between hypokalemia and clinical severity (P = 0.02), and between abdominal pain and severity of DKA (P = 0.003). No deaths occurred. Conclusions: DKA was most prevalent in newly diagnosed TIDM cases. Most cases had severe DKA. Female children, in particular, seem to be at increased risk for severe DKA. Newly diagnosed T1DM and insulin omission were the main factors associated with DKA. The age of presentation and clinical symptoms of studied subjects were similar to international studies. No lethal complication was recorded. High frequency of DKA at presentation of T1DM requires careful attention to issues of early diagnosis before development of ketoacidosis.