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The relationship between hyperchloremia and acute kidney injury in pediatric diabetic ketoacidosis and its impact on clinical outcomes

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Abstract

Introduction

Diabetic ketoacidosis (DKA) is characterized by hyperglycemia, ketogenesis, and increased anion gap metabolic acidosis. Such derangements are accompanied by volume depletion as well as electrolyte disturbances. Resuscitation using traditional saline in DKA patients can exacerbate electrolyte abnormalities, in particular the production of hyperchloremia. Severe hypovolemia can result in acute kidney injury (AKI). The link between hyperchloremia and AKI is controversial. This study aimed to assess the relationship between hyperchloremia and AKI in pediatric patients with DKA and its impacts on clinical outcomes.

Methods

This cross-sectional study was conducted on 70 children with DKA admitted to the pediatric intensive care unit in which all patients were subjected to detailed medical history taking and full clinical examination. Daily assessment of Na, K, urea, creatinine, chloride, arterial blood gases, and albumin/creatinine ratio (ACR) was done. AKI was defined as pRIFLE stage I and F.

Results

Hyperchloremia was detected in 65.7% of patients at admission and in 52.9% after 24 h (p = 0.17). AKI was documented in 28% of patients. At admission hyperchloremia was detected in 56% of patients without AKI versus 90% of patients with AKI (p = 0.007). After 24 h, hyperchloremia was detected in 48.4% patients without versus 100% of patients with AKI. Chloride was significantly positively correlated to duration of admission, creatinine, ACR, and negatively correlated to eGFR.

Conclusion

The development of AKI in patients with DKA was accompanied by hyperchloremia, increased time to DKA resolution, and longer hospital stay.

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Change history

  • 22 May 2022

    The name Rehab Muhammad Abd El kareem has been tagged correctly.

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Authors and Affiliations

  1. Department of Pediatrics, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt

    Heba Mostafa Ahmed, Hagar Ramadan Hasb Elnaby & Mahmoud Hodeib

  2. Department of Clinical and Chemical Pathology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt

    Rehab Muhammad Abd El kareem

Authors
  1. Heba Mostafa Ahmed
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  2. Hagar Ramadan Hasb Elnaby
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  3. Rehab Muhammad Abd El kareem
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  4. Mahmoud Hodeib
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Correspondence to Heba Mostafa Ahmed.

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Ethics approval

This study was approved by the local ethical committee of the faculty of Medicine, Beni-Suef University (FMBSUREC /03122019. FWA00015574).

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An informed written consent was obtained from the care givers of the included participants.

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The authors declare no competing interests.

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Ahmed, H.M., Elnaby, H.R.H., El kareem, R.M.A. et al. The relationship between hyperchloremia and acute kidney injury in pediatric diabetic ketoacidosis and its impact on clinical outcomes. Pediatr Nephrol 37, 1407–1413 (2022). https://doi.org/10.1007/s00467-021-05279-2

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  • DOI: https://doi.org/10.1007/s00467-021-05279-2

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