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

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Abstract

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.

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References

  1. Levitsky L, Ekwo E, Goselink CA, Solomon EL, Aceto T. Death from diabetes (DM) in hospitalized children (1970–1998). Pediatr Res. 1991;29:21–4.

    Google Scholar 

  2. Curtis JR, To T, Muirhead S, Cummings E, Daneman D. Recent trends in hospitalization for diabetic ketoacidosis in Ontario children. Diabetes Care. 2002;25(9):1591–6.

    Article  PubMed  Google Scholar 

  3. Lawrence SE, Cummings EA, Gaboury I, Daneman D. Population-based study of incidence and risk factors for cerebral edema in pediatric diabetic ketoacidosis. J Pediatr. 2005;146(5):688–92.

    Article  PubMed  Google Scholar 

  4. Edge JA, Ford-Adams ME, Dunger DB. Causes of death in children with insulin dependent diabetes 1990–96. Arch Dis Child. 1999;81(4):318–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Wolfsdorf J, Glaser N, Sperling MA. Diabetic ketoacidosis in infants, children, and adolescents—a consensus statement from the American Diabetes Association. Diabetes Care. 2006;29(5):1150–59.

    Article  PubMed  Google Scholar 

  6. Edge JA, Hawkins MM, Winter DL, Dunger DB. The risk and outcome of cerebral edema developing during diabetic ketoacidosis. Arch Dis Child. 2001;85(1):16–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Syed M, Khawaja FB, Saleem T, Khalid U, Rashid A, Humayun KN. Clinical profile and outcomes of pediatric patients with diabetic keto acidosis at a tertiary care hospital in Pakistan. J Pak Med Assoc. 2011;61(11):1082–87.

    PubMed  Google Scholar 

  8. Lone SW, Fareeduddin M, Irum A, Ibrahim MN, Raza J. Frequency, clinical characteristics and outcome of diabetic ketoacidosis in children with type-1 diabetes at a tertiary care hospital. J Pak Med Assoc. 2010;60(9):725–9.

    PubMed  Google Scholar 

  9. Jayashree M, Singhi S. Diabetic ketoacidosis: predictors of outcome in a pediatric intensive care unit of a developing country. Pediatr Crit Care Med. 2004;5(5):427–33.

    Article  CAS  PubMed  Google Scholar 

  10. Lokesh Kumar T, Jayashree M, Singhi S. Risk factors for cerebral edema in diabetic ketoacidosis in a developing country: role of fluid refractory shock. Pediatr Crit Care Med. 2012;13(2):e 91–96.

    Article  Google Scholar 

  11. Kanwal SK, Bando A, Kumar V. Clinical profile of diabetic ketoacidosis in Indian children. Indian J Pediatr. 2012;79(7):901–4.

    Article  PubMed  Google Scholar 

  12. Prasad D, Arpita, Shally A. A retrospective case study of clinical profile of hospitalized children with type 1 diabetes mellitus at a tertiary health care center in northern India. Clinical Epidemiology and Global Health. 2013. doi.org/10.1016/j.cegh.2013.02.002.

  13. Ganesh R, Arvindkumar R, Vasanthi T. Clinical profile and outcome of diabetic ketoacidosis in children. Natl Med J India. 2009;22(1):18-–19.

    PubMed  Google Scholar 

  14. Jahagirdar RR, Khadilkar VV, Khadilkar AV, Lalwani SK. Management of diabetic ketoacidosis in PICU. Indian J Pediatr. 2007;74(6):551–4.

    Article  CAS  PubMed  Google Scholar 

  15. Zabeen B, Nahar J, Mohsin F, Azad K, Nahar N. DKA in children—an experience in a tertiary hospital. Ibrahim Medical Coll J. 2008;2(1):17–20.

    Google Scholar 

  16. Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn K, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71:1028.

    Article  CAS  PubMed  Google Scholar 

  17. Shabir A, Muzaffar J, Ishrat R, Tariq R, Naveed S. Clinical profile and outcome of pediatric patients with diabetic ketoacidosis IOSR. J Dent Med Sci (IOSR-JDMS). 2015;14(3):22–6. doi:10.9790/0853-14332226.

    Google Scholar 

  18. Jeffersson P, Viva Lago PM. A warning from India: hypovolemia may be as dangerous as excessive fluid infusion for cerebral edema in diabetic Ketoacidosis. Pediatr Crit Care Med. 2012;13(2):236–7.

    Article  Google Scholar 

  19. Afshin SA, Shohreh M, Morteza EB. Diabetic keto acidosis and its complications among children. Acta Med Iran. 2011;49(2):113–4.

    Google Scholar 

  20. Poovazhagi V, Prabha S, Padmaraj R. Outcome of acute renal failure in children with DKA. Pediatric Oncall. 2011;8(3):63–5.

    Google Scholar 

  21. Wolfsdorf JI, Allgrove J, Craig ME, et al. A consensus statement from the international society for pediatric and adolescent diabetes: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2014;15 Suppl 20:154–79.

    Article  CAS  PubMed  Google Scholar 

  22. Mallare JT, Cordice CC, Ryan BA, Carey DE, et al. Identifying risk factors for the development of diabetic ketoacidosis in new onset type 1 diabetes mellitus. Clin Pediatr. 2003;42(7):591–7.

    Article  Google Scholar 

  23. Bui H, To T, SteinR FK, Daneman D. Diabetic ketoacidosis at disease onset a result of missed diagnosis? J Pediatr. 2010;156(3):472–7.

    Article  PubMed  Google Scholar 

  24. Ali K, Hamden A, Edge JA. Easily missed? Type 1 diabetes in children. BMJ. 2011;342:d294.

    Article  PubMed  Google Scholar 

  25. Murunga AN, Owira PMO. Review diabetic ketoacidosis: an overlooked child killer in sub-Saharan Africa? Trop Med Int Health. 2013;18(11):1357–64. doi:10.1111/tmi.12195.

    Article  CAS  PubMed  Google Scholar 

  26. Vanelli M, Scarabello C, Fainardi V. Available tools for primary ketoacidosis prevention at diabetes diagnosis in children and adolescents. “The Parma campaign”. Acta Biomed. 2008;79(1):73–8.

    PubMed  Google Scholar 

  27. Vanelli M, Chiari G, Ghizzoni L, Costi G, Giacalone T, Chiarelli F. Effectiveness of a prevention program for diabetic ketoacidosis in children. An 8-year study in schools and private practices. Diabetes Care. 1999;22:7–9. doi:10.2337/diacare.22.1.7.

    Article  CAS  PubMed  Google Scholar 

  28. Vanelli M, Chiari G, Lacava S, Iovane B. Campaign for diabetic ketoacidosis prevention still effective 8 years later. Diabetes Care. 2007;30:e12.

    Article  PubMed  Google Scholar 

  29. King BR, Howard NJ, Verge CF, et al. A diabetes awareness campaign prevents diabetic ketoacidosis in children at their initial presentation with type 1 diabetes. Pediatr Diabetes. 2012;13(8):647–51. doi:10.1111/j.1399-5448.2012.00896.x.

    Article  PubMed  Google Scholar 

  30. Lansdown AJ, Barton J, Warner J, et al. Prevalence of ketoacidosis at diagnosis of childhood onset type 1 diabetes in wales from 1991 to 2009 and effect of a publicity campaign. Diabet Med. 2012;29:1506–9.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The author likes to acknowledge Retd. Prof. Dr. Saradha Suresh, for the help in conducting this study and critical review of the write-up.

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Authors and Affiliations

  1. Chengalpattu Medical College, Chengalpattu, Tamil Nadu, India

    V. Poovazhagi

  2. No 8/11 Manjolai street Kalaimagal Nagar, Ekkaduthangal, Chennai, 600 032, Tamil Nadu, India

    V. Poovazhagi

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Correspondence to V. Poovazhagi.

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Poovazhagi, V. Factors associated with mortality in children with diabetic ketoacidosis (DKA) in South India. Int J Diabetes Dev Ctries 36, 295–302 (2016). https://doi.org/10.1007/s13410-015-0441-x

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  • DOI: https://doi.org/10.1007/s13410-015-0441-x

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