Clinical profile and outcome of the children with diabetic ketoacidosis (DKA) in hilly Himalayan state of north India

Abstract

Background: Context: DKA is an important complication of undiagnosed or poorly controlled diabetes mellitus. Proper management of DKA can prevent morbidity and mortality attributable to diabetes mellitus. The aim of the research was to study the clinical profile and outcome of the children admitted with Diabetic Ketoacidosis (DKA).Methods: A descriptive retrospective study was conducted in pediatric ICU of tertiary level care hospital over three years between January 2013 and December 2015. 29 patients were diagnosed with DKA during the three-year period, the data was collected by reviewing the medical record of the patient and information with respect to personal details, clinical features, laboratory parameters, management and outcome was recorded.Results: 29 patients were diagnosed with DKA, of these 17 were males and 12 females. M:F was 1.4:1 and mean age at presentation was 11.4±4.4 yrs. DKA was the presenting manifestation of Diabetes in 48.2% patients and 51.8% were already known cases of Diabetes. Abdominal pain (62%), polyuria (58.6%), fast breathing (58.6%), vomiting (55.1%), and altered sensorium (44.8%) were common presenting symptoms of DKA. Severe ketoacidosis was noted in 48.2% and severe dehydration in 31%. Shock was observed in 27.5% patients and 20.9% had cerebral edema. Metabolic abnormalities like hponatremia, hypernatremia, hyperkalemia, hypokalemia were seen in 44.8%, 13.7%, 24.1%, 17.2% respectively. We had 1 (3.4%) mortality.Conclusions: Diabetic Ketoacidosis (DKA) is an important cause of hospital admissions and 48.2% of newly diagnosed cases presented with DKA. Infections and omission of the insulin were the most common precipitating factors. For the long- term management strategy it is important to educate of the patients and their parents regarding regular blood sugar monitoring and insulin dosing.