Keywords
Onset of diabetes
Cerebral edema
Mortality
Children
Adolescents
Pandemic
How to Cite
Abstract
Background: Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency in type 1 diabetic patients (1). The objective of this study is to describe the sociodemographic, clinical characteristics and complications of each of the episodes of DKA in patients under 18 years of age in a referral center in Bogotá, Colombia during the period from August 1, 2017 to August 31. August 2022.
Purpose: To characterize the clinical and paraclinical behavior, complications and treatment of each of the episodes of diabetic ketoacidosis in patients under 18 years of age at the San Ignacio Hospital in Bogotá in the period from August 1, 2017 to August 31, 2022 corresponding to the pre-pandemic period (until March 2020) and in the pandemic (since March 2020).
Methodology: A retrospective descriptive study was carried out including all patients who met CAD criteria defined by ISPAD 2018 (3).
Results: 15 patients were included, 66.6% female, 40% new, 60% already known to have diabetes, of these only 33% used technology, with a mean value of HbA1c of 12.6%. Most episodes were mild to moderate, the most frequent symptoms were abdominal pain and emesis (54%) followed by polyuria and polydipsia (48%), lasting more than 48 hours. 86.7% received intravenous insulin management and met DKA resolution criteria in less than 48 hours, with a median intravenous insulin management time of 16 hours. Without diagnosis of cerebral edema or mortality. Median hospital stay of 202 hours.
Conclusions: DKA is a complication that, in our institution, occurs mainly in patients with a previous diagnosis of type 1 diabetes mellitus (DM1), with mild to moderate symptoms with classic symptoms, which in our institution was not associated with mortality.
References
Dhatariya KK, Glaser NS, Codner E, Umpierrez GE. Diabetic ketoacidosis. Nat Rev Dis Primers. 2020;6(1):40. https://doi.org/10.1038/s41572-020-0165-1
Long B, Koyfman A. Emergency medicine myths: cerebral edema in pediatric diabetic ketoacidosis and intravenous fluids. J Emerg Med. 2017;53(2):212-21. https://doi.org/10.1016/j.jemermed.2017.03.014
Wolfsdorf JI, Glaser N, Agus M, Fritsch M, Hanas R, Rewers A, et al. ISPAD Clinical Practice Consensus Guidelines 2018: diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes. 2018;19(supl. 27):155-77. https://doi.org/10.1111/pedi.12701
Glaser N, Fritsch M, Priyambada L, Rewers A, Cherubini V, Estrada S, et al. ISPAD Clinical Practice Consensus Guidelines 2022: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2022;23(7):835-56. https://doi.org/10.1111/pedi.13406
Kostopoulou E, Sinopidis X, Fouzas S, Gkentzi D, Dassios T, Roupakias S, et al. Diabetic ketoacidosis in children and adolescents; diagnostic and therapeutic pitfalls. Diagnostics. 2023;13(15):2602. https://doi.org/10.3390/diagnostics13152602
Ballesteros Calderón AL, Meneses Muñoz AP, Ríos Patiño D, Flórez Gómez ID, Quevedo Vélez A. Características epidemiológicas y clínicas y hallazgos de laboratorio de los niños menores de 15 años con cetoacidosis diabética atendidos en el Hospital Universitario San Vicente Fundación en Medellín, Colombia, entre enero de 2001 y diciembre de 2010. Iatreia. 2013;26(3):278-90. https://doi.org/10.17533/udea.iatreia.14297
Del Pozo P, Aránguiz D, Córdova G, Scheu C, Valle P, Cerda J, et al. Clinical profile of children with diabetic ketoacidosis in fifteen years of management in a Critical Care Unit. Rev Chil Pediatr. 2018;89(4):491-8. https://doi.org/10.4067/s0370-41062018005000703
Musoma SN, Omar A, Mutai BC, Laigong P. Outcomes of children and adolescents admitted with diabetic ketoacidosis at Kenyatta National Hospital (KNH), Kenya. J Diabetes Res. 2020;2020:8987403. https://doi.org/10.1155/2020/8987403
Alzate Flórez JA, Alzate Ramos SA, Castaño Castrillón JJ, González Cuartas J, Herrera Bustamante M, Herrera Muñoz V, et al. Morbimortalidad de los pacientes con cetoacidosis diabética que ingresaron a la unidad de cuidados intensivos pediátricos del Hospital Infantil Universitario de la Cruz Roja, Rafael Henao Toro, de la ciudad de Manizales (Colombia), 2004-2010. Arch Med. 2012;12(2):168-77. https://doi.org/10.30554/archmed.12.2.4.2012
Cherubini V, Marino M, Scaramuzza AE, Tiberi V, Bobbio A, Delvecchio M, et al. The silent epidemic of diabetic ketoacidosis at diagnosis of type 1 diabetes in children and adolescents in italy during the COVID-19 pandemic in 2020. Front Endocrinol. 2022;13:878634. https://doi.org/10.3389/fendo.2022.878634
Rahmati M, Keshvari M, Mirnasuri S, Yon DK, Lee SW, Il Shin J, et al. The global impact of COVID-19 pandemic on the incidence of pediatric new-onset type 1 diabetes and ketoacidosis: a systematic review and meta-analysis. J Med Virol. 2022;94(11):5112-27. https://doi.org/10.1002/jmv.27996
Lah Tomuli? K, Matko L, Verbi? A, Milardovi? A, Severinski S, Koli? I, et al. Epidemiologic characteristics of children with diabetic ketoacidosis treated in a pediatric intensive care unit in a 10-year-period: single centre experience in Croatia. Medicina. 2022;58(5):638. https://doi.org/10.3390/medicina58050638
Peng W, Yuan J, Chiavaroli V, Dong G, Huang K, Wu W, et al. 10-year incidence of diabetic ketoacidosis at type 1 diabetes diagnosis in children aged less than 16 years from a Large Regional Center (Hangzhou, China). Front Endocrinol. 2021;12:653519. https://doi.org/10.3389%2Ffendo.2021.653519
González Pannia P, Balboa R, Navarro R, Nocita MF, Ferraro M, Mannucci C. Prevalence of cerebral edema among diabetic ketoacidosis patients. Arch Argent Pediatr. 2020;118(5):332-6. http://dx.doi.org/10.5546/aap.2020.eng.332
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2024 Revista Colombiana de Endocrinología, Diabetes & Metabolismo