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Diabetic ketoacidosis: predictors of outcome in a pediatric intensive care unit of a developing country.
Pediatr Crit Care Med 2004; 5(5):427-33PC

Abstract

OBJECTIVES

To study the outcome and predictors of mortality in children with diabetic ketoacidosis.

DESIGN

Retrospective case series.

SETTING

Pediatric intensive care unit of an urban multiple-specialty teaching and referral hospital in north India.

PATIENTS

Sixty-eight patients with diabetic ketoacidosis treated between 1993 and 2000.

INTERVENTIONS

Data were retrieved from case records with respect to patients' age; clinical features; osmolality at admission; blood glucose, serum potassium, and arterial pH at admission, 6 hrs, and 24 hrs; complications during the course of hospital stay; treatment; and outcome in terms of survival or death. Survivors and nonsurvivors were compared to determine the predictors of mortality.

MEASUREMENTS AND MAIN RESULTS

The mean (sd) age of the study population was 6.9 (3.5) yrs (range, 0.5-12 yrs). Impaired consciousness (n = 45; 66%), rapid breathing (n = 41; 60%), and vomiting (n = 35; 51.4%) were common presenting symptoms. Thirty-two (50%) patients had clinically evident dehydration. Precipitating events identified were new-onset diabetes with sepsis (37%), new-onset diabetes alone (31%), insulin omission (15%), and infection with insulin omission (7%). The mean (sd) blood glucose, osmolality, and pH at admission were 473 (sd 184) mg/dL, 305 (sd 24) mOsm/L, and 7.08 (sd 0.1), respectively. Complications noted during treatment were hypokalemia (n = 28; 41%), hypoglycemia (n = 10; 15%), cerebral edema (n = 9; 13.2%), and pulmonary edema (n = 2; 3%). Nine (13.2%) patient died, with the causes of death being septic shock (n = 4), cerebral edema (n = 2), cerebral edema with pulmonary edema (n = 2), and hypokalemia with ventricular tachycardia (n = 1). Those who died were older, had higher osmolality and severe acidosis at admission, and had persistent hyperglycemia and acidosis at 6-12 hrs. On multiple logistic regression analysis, osmolality at admission was the most significant predictor of death.

CONCLUSIONS

Two thirds of children with diabetic ketoacidosis in our series had new-onset diabetes, and 13.2% died. Serum osmolality at admission was the most important predictor of death.

Authors+Show Affiliations

Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15329157

Citation

Jayashree, M, and Sunit Singhi. "Diabetic Ketoacidosis: Predictors of Outcome in a Pediatric Intensive Care Unit of a Developing Country." Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, vol. 5, no. 5, 2004, pp. 427-33.
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):427-33.
Jayashree, M., & Singhi, S. (2004). Diabetic ketoacidosis: predictors of outcome in a pediatric intensive care unit of a developing country. Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 5(5), pp. 427-33.
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):427-33. PubMed PMID: 15329157.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diabetic ketoacidosis: predictors of outcome in a pediatric intensive care unit of a developing country. AU - Jayashree,M, AU - Singhi,Sunit, PY - 2004/8/27/pubmed PY - 2005/1/26/medline PY - 2004/8/27/entrez SP - 427 EP - 33 JF - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JO - Pediatr Crit Care Med VL - 5 IS - 5 N2 - OBJECTIVES: To study the outcome and predictors of mortality in children with diabetic ketoacidosis. DESIGN: Retrospective case series. SETTING: Pediatric intensive care unit of an urban multiple-specialty teaching and referral hospital in north India. PATIENTS: Sixty-eight patients with diabetic ketoacidosis treated between 1993 and 2000. INTERVENTIONS: Data were retrieved from case records with respect to patients' age; clinical features; osmolality at admission; blood glucose, serum potassium, and arterial pH at admission, 6 hrs, and 24 hrs; complications during the course of hospital stay; treatment; and outcome in terms of survival or death. Survivors and nonsurvivors were compared to determine the predictors of mortality. MEASUREMENTS AND MAIN RESULTS: The mean (sd) age of the study population was 6.9 (3.5) yrs (range, 0.5-12 yrs). Impaired consciousness (n = 45; 66%), rapid breathing (n = 41; 60%), and vomiting (n = 35; 51.4%) were common presenting symptoms. Thirty-two (50%) patients had clinically evident dehydration. Precipitating events identified were new-onset diabetes with sepsis (37%), new-onset diabetes alone (31%), insulin omission (15%), and infection with insulin omission (7%). The mean (sd) blood glucose, osmolality, and pH at admission were 473 (sd 184) mg/dL, 305 (sd 24) mOsm/L, and 7.08 (sd 0.1), respectively. Complications noted during treatment were hypokalemia (n = 28; 41%), hypoglycemia (n = 10; 15%), cerebral edema (n = 9; 13.2%), and pulmonary edema (n = 2; 3%). Nine (13.2%) patient died, with the causes of death being septic shock (n = 4), cerebral edema (n = 2), cerebral edema with pulmonary edema (n = 2), and hypokalemia with ventricular tachycardia (n = 1). Those who died were older, had higher osmolality and severe acidosis at admission, and had persistent hyperglycemia and acidosis at 6-12 hrs. On multiple logistic regression analysis, osmolality at admission was the most significant predictor of death. CONCLUSIONS: Two thirds of children with diabetic ketoacidosis in our series had new-onset diabetes, and 13.2% died. Serum osmolality at admission was the most important predictor of death. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/15329157/Diabetic_ketoacidosis:_predictors_of_outcome_in_a_pediatric_intensive_care_unit_of_a_developing_country_ L2 - http://Insights.ovid.com/pubmed?pmid=15329157 DB - PRIME DP - Unbound Medicine ER -