Volume : 09, Issue : 04, April – 2022
Title:
26.DIABETIC KETOACIDOSIS IN PAEDIATRICS, RISK FACTORS, AND COMPLICATIONS
Authors :
Dr Zeyad .H.Alhazmy,Dr.Deena .N.Bedaiwi,Dr.Leena .N.Bedaiwi
Abstract :
Diabetic ketoacidosis (DKA) is the most common hyperglycaemic emergency in patients with diabetes mellitus. DKA most often occurs in patients with type 1 diabetes, but patients with type 2 diabetes are susceptible to DKA under stressful conditions, such as trauma, surgery, or infections. We conducted search through electronic databases for relevant studies published up to 2021. Our aim through this narrative review was to discuss the most common risk factors, and complications of DKA among children. Worldwide, infection is the most common precipitating cause for DKA, occurring in 30–50% of cases. Urinary tract infection and pneumonia account for the majority of infections. Other precipitating causes are intercurrent illnesses (i.e., surgery, trauma, myocardial ischemia, pancreatitis), psychological stress, and noncompliance with insulin therapy. The triad of uncontrolled hyperglycaemia, metabolic acidosis and increased total body ketone concentration characterizes DKA.
Cite This Article:
Please cite this article in press Zeyad .H.Alhazmy et al, Diabetic Ketoacidosis In Paediatrics, Risk Factors, And Complications., Indo Am. J. P. Sci, 2022; 09(04).,
Number of Downloads : 10
References:
1. Gagnum V, Stene LC, Jenssen TG, et al. Causes of death in childhood onset type 1 diabetes: long-term follow-up. Diabet Med. 2017;34:56-63.
2. Patterson CC, Dahlquist G, Harjutsalo V, et al. Early mortality in EURODIAB population-based cohorts of type 1 diabetes diagnosed in childhood since 1989. Diabetologia. 2007;50:2439-2442.
3. Morgan E, Black CR, Abid N, Cardwell CR, McCance DR, Patterson CC. Mortality in type 1 diabetes diagnosed in childhood in Northern Ireland during 1989-2012: a population-based cohort study. Pediatr Diabetes. 2018;19:166-170.
4. Wolfsdorf JI, Glaser N, Agus M, et al. ISPAD Clinical Practice Consensus Guidelines 2018: diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes. 2018;19(27):155-177.
5. Glaser N, Barnett P, McCaslin I, et al. Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. N Engl J Med. 2001;344:264-269.
6. Hursh BE, Ronsley R, Islam N, Mammen C, Panagiotopoulos C. Acute kidney injury in children with type 1 diabetes hospitalized for diabetic ketoacidosis. JAMA Pediatr. 2017;171:e170020.
7. Ghetti S, Lee JK, Sims CE, Demaster DM, Glaser NS. Diabetic ketoacidosis and memory dysfunction in children with type 1 diabetes. J Pediatr. 2010;156:109-114.
8. Aye T, Mazaika PK, Mauras N, et al. Impact of early diabetic ketoacidosis on the developing brain. Diabetes Care. 2019;42: 443-449.
9. Cherubini V, Grimsmann JM, Åkesson K, et al. Temporal trends in diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes between 2006 and 2016: results from 13 countries in three continents. Diabetologia. 2020;63:1530-1541. https://doi.org/10.1007/s00125-020- 05152-1.
10. Mallare JT, Cordice CC, Ryan BA, Carey DE, Kreitzer PM, Frank GR. Identifying risk factors for the development of diabetic ketoacidosis in new onset type 1 diabetes mellitus. Clin Pediatr 2003: 42: 591–597.
11. MŁynarski W, ZmysŁowska A, Kubryn I, Perenc M, Bodalski J. Factors involved in ketoacidosis at the onset of type 1 diabetes in childhood. Endokr Diabetol Chor Przemiany Materii Wieku Rozw 2003: 9: 23–28.
12. Kunishige M, Sekimoto E, Komatsu M, Bando Y, Uehara H,Izumi K. Thyrotoxicosis masked by diabetic ketoacidosis: a fatal complication. Diabetes Care 2001: 24: 171.
13. Komulainen J, Lounamaa R, Knip M, Kaprio EA, Hans K, Akerblom HK. Ketoacidosis at the diagnosis of type 1 (insulin dependent) diabetes mellitus is related to poor residual beta cell function. Childhood Diabetes in Finland Study Group. Arch Dis Child 1996: 75: 410–415.
14. Chase HP, MacKenzieb TA, Burdick J et al. Redefining the clinical remission period in children with type 1 diabetes. Pediatr Diabetes 2004: 5: 16–19.
15. Wolfsdorf J, Glaser N, Sperling MA; American Diabetes Association. Diabetic ketoacidosis in infants, children, and adolescents: A consensus statement from the American Diabetes Association. Diabetes Care. 2006;29:1150–1159.
16. Dunger DB, Sperling MA, Acerini CL, Bohn DJ, Daneman D, Danne TP, Glaser NS, Hanas R, Hintz RL, Levitsky LL, et al. European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society consensus statement on diabetic ketoacidosis in children and adolescents. Pediatrics. 2004;113:e133–e140.
17. Edge JA, Ford-Adams ME, Dunger DB. Causes of death in children with insulin dependent diabetes 1990-96. Arch Dis Child. 1999;81:318–323.
18. Rosenbauer J, Dost A, Karges B, et al. Improved metabolic control in children and adolescents with type 1 diabetes: a trend analysis using prospective multicenter data from Germany and Austria. Diabetes Care. 2012;35:80-86.
19. Szypowska A, Skórka A. The risk factors of ketoacidosis in children with newly diagnosed type 1 diabetes mellitus. Pediatr Diabetes. 2011 Jun;12(4 Pt 1):302-6. doi: 10.1111/j.1399-5448.2010.00689.x. Epub 2010 Dec 5.
20. Mallare JT, Cordice CC, Ryan BA, Carey DE, Kreitzer PM, Frank GR. Identifying risk factors for the development of diabetic ketoacidosis in new onset type 1 diabetes mellitus. Clin Pediatr 2003: 42: 591–597.
21. Vanelli M, Chiari G, Lacava S, Iovane B. Campaign for diabetic ketoacidosis prevention still effective 8 years later. Diabetes Care 2007: 30: e12.
22. Hathout EH, Hartwick N, Fagoaga OR et al. Clinical, autoimmune, and HLA characteristics of children diagnosed with type 1 diabetes before 5 years of age. Pediatrics 2003: 111: 860–863.
23. Pundziute-Lycka A, Dahlquist G, Nystrom L et al. The incidence of T1D has not increased but shifted to a younger age at diagnosis in the 0–34 year group in Sweden, 1983–1998. Diabetologia 2002: 45: 783–791.
24. Curtis JR, To T, Muirhead S, Cummings E, Daneman D. Recent trends in hospitalization for diabetic ketoacidosis in Ontario children. Diabetes Care 2002: 25: 1591–1596.
25. Oyarzabal M, Chueca M, Berrade S et al. Ketoacidosis in the diagnosis of type 1 diabetes mellitus in Spain. Pediatr Diabetes 2009: 10: 76.
26. Keenan HT, Foster CM, Bratton SL. Social factors associated with prolonged hospitalization among diabetic children. Pediatrics 2002: 109: 40–44.
27. Roche EF, Menon A, Gill D, Hoey H. Clinical presentation of type 1 diabetes. Pediatr Diabetes 2005: 6: 75–78.
28. Edge JA, Hawkins MM, Winter DL, Dunger DB. The risk and outcome of cerebral oedema developing during diabetic ketoacidosis. Arch Dis Child. 2001;85:16–22.
29. 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;146:688–692.
30. Marcin JP, Glaser N, Barnett P, McCaslin I, Nelson D, Trainor J, Louie J, Kaufman F, Quayle K, Roback M, et al. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. J Pediatr. 2002;141:793–797.
31. Glaser N, Barnett P, McCaslin I, Nelson D, Trainor J, Louie J, Kaufman F, Quayle K, Roback M, Malley R, Kuppermann N; Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. N Engl J Med. 2001;344:264–269.
32. Glaser NS, Marcin JP, Wootton-Gorges SL, Buonocore MH, Rewers A, Strain J, DiCarlo J, Neely EK, Barnes P, Kuppermann N. Correlation of clinical and biochemical findings with diabetic ketoacidosis-related cerebral edema in children using magnetic resonance diffusion-weighted imaging. J Pediatr. 2008;153:541–546.
33. Carlotti AP, Bohn D, Halperin ML. Importance of timing of risk factors for cerebral oedema during therapy for diabetic ketoacidosis. Arch Dis Child. 2003;88:170–173.
34. Lam TI, Anderson SE, Glaser N, O’Donnell ME. Bumetanide reduces cerebral edema formation in rats with diabetic ketoacidosis. Diabetes. 2005;54:510–516.
35. Beck C, Dubois J, Grignon A, Lacroix J, David M. Incidence and risk factors of catheter-related deep vein thrombosis in a pediatric intensive care unit: a prospective study. J Pediatr. 1998;133:237–241.
36. Gutierrez JA, Bagatell R, Samson MP, Theodorou AA, Berg RA. Femoral central venous catheter-associated deep venous thrombosis in children with diabetic ketoacidosis. Crit Care Med. 2003;31:80–83.
37. Worly JM, Fortenberry JD, Hansen I, Chambliss CR, Stockwell J. Deep venous thrombosis in children with diabetic ketoacidosis and femoral central venous catheters. Pediatrics. 2004;113:e57–e60.
38. deVeber G, Andrew M, Adams C, Bjornson B, Booth F, Buckley DJ, Camfield CS, David M, Humphreys P, Langevin P, et al. Cerebral sinovenous thrombosis in children. N Engl J Med. 2001;345:417–423.
39. Keane S, Gallagher A, Ackroyd S, McShane MA, Edge JA. Cerebral venous thrombosis during diabetic ketoacidosis. Arch Dis Child. 2002;86:204–205.
40. Sasiadek MJ, Sosnowska-Pacuszko D, Zielinska M, Turek T. Cerebral venous thrombosis as a first presentation of diabetes. Pediatr Neurol. 2006;35:135–138.