Volume : 09, Issue : 11, November – 2022

Title:

19.VARIATION OF COMPLICATIONS IN CHILDREN ADMITTED IN INTENSIVE CARE UNIT WITH SEVERE DKA

Authors :

Dr Anum Afzal , Dr. Noor ul Ain Zia, Dr. Mohammad Ahsan Anwaar

Abstract :

Objectives: To describe the spectrum of complications of Diabetic Ketoacidosis (DKA) observed in children admitted with severe DKA.
Methods: Retrospective review of the medical records of all children admitted with the diagnosis of severe DKA in Pediatric Intensive Care Unit (PICU) of Allied Hospital, Faisalabad, from January 2020 to December 2021 was done. Data was collected on a structured proforma and descriptive statistics were applied.
Results: Total 37 children were admitted with complicated DKA (1.9% of total PICU admission with 1.8% in 2020 and 3.4% in 2021). Mean age of study population was 8.1±4.6 years and 70% were females (26/37). Mean Prism III score was 9.4±6, mean GCS on presentation was 11±3.8 and mean lowest pH was 7.00±0.15. Complications observed included hyperchloremia (35.94%), hypokalemia (30.81%), hyponatremia (26.70%), cerebral edema (16.43%), shock (13.35%), acute kidney injury (10.27%), arrhythmias (3.8%), and thrombotic thrombocytopenic purpura (5.4%), while one patient had myocarditis and ARDS each. 13/37 children (35%) needed inotropic support, 11/37 (30%) required mechanical ventilation while only one patient required renal replacement therapy. Two patients (5.4%) died during their PICU stay.

Cite This Article:

Please cite this article in press Anum Afzal et al, Variation Of Complications In Children Admitted In Intensive Care Unit With Severe DKA., Indo Am. J. P. Sci, 2022; 09(11).

Number of Downloads : 10

References:

1. Group DP. Incidence and trends of childhood Type 1 diabetes worldwide 1990-1999. Diabet Med. 2006;23(8):857-866. doi: 10.1001/jama.2020.3201.
2. Neu A, Willasch A, Ehehalt S, Hub R, Ranke MB, Baden-Wuerttemberg DG. Ketoacidosis at onset of type 1 diabetes mellitus in children–frequency and clinical presentation. Pediatr Diabetes. 2003;4(2):77-81. doi: 10.5772/60592.
3. Edge JA, Ford-Adams ME, Dunger DB. Causes of death in children with insulin dependent diabetes 1990-96. Arch Dis Child. 1999;81(4):318-323.
4. Bialo SR, Agrawal S, Boney CM, Quintos JB. Rare complications of pediatric diabetic ketoacidosis. World J Diabetes. 2021;6(1):167-174. doi: 10.4239/wjd.v6.i1.167.
5. Siqueira LF. Cerebrovascular complications of diabetic ketoacidosis in children. Arq Bras Endocrinol Metabol. 2011;55(4):288-290. doi: 10.1093/tropej/fmw088.
6. Asl AS, Maleknejad S, Kelachaye ME. Diabetic ketoacidosis and its complications among children. Acta Med Iran. 2011;49(2):113-114.
7. Khan MR, Maheshwari PK, Haque A. Thrombotic microangiopathic syndrome: a novel complication of diabetic ketoacidosis. Indian Pediatr. 2013;50(7):697-699.
8. 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):427-433. doi: 10.1097/01.PCC.0000137987.74235.5E.
9. Wolfsdorf JI, Allgrove J, Craig ME, Edge J, Glaser N, Jain V, et al. ISPAD Clinical Practice Consensus Guidelines 2020. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2020;15(Suppl 20):154-179. doi: 10.1111/pedi.12165.
10. So TY, Grunewalder E. Evaluation of the two-bag system for fluid management in pediatric patients with diabetic ketoacidosis. J Pediatr Pharmacol Ther. 2020;14(2):100-105. doi: 10.5863/1551-6776-14.2.100.

11. Kleinman ME, Chameides L, Schexnayder SM, Samson RA, Hazinski MF, Atkins DL, et al. Part 14: pediatric advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;122(18 Suppl 3):S876-S908. doi: 10.1161/CIRCULATIONAHA.110.971101.
12. Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK,
Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71(10):1028-1035. doi: 10.1097/PCC.0b013e3182745675.
13. Freire AX, Umpierrez GE, Afessa B, Latif KA, Bridges L, Kitabchi AE. Predictors of intensive care unit and hospital length of stay in diabetic ketoacidosis. J Crit Care. 2002;17(4):207-211.
14. Mrozik LT, Yung M. Hyperchloraemic metabolic acidosis slows recovery in children with diabetic ketoacidosis: a retrospective audit. Aust Crit Care. 2020;22(4):172-177.
15. Mahler SA, Conrad SA, Wang H, Arnold TC. Resuscitation with balanced electrolyte solution prevents hyperchloremic metabolic acidosis in patients with diabetic ketoacidosis. Am J Emerg Med. 2011;29(6):670-674. doi: 10.1016/j. ajem.2020.02.004.