Prevalence of abnormal serum sodium and potassium concentration in paediatric new onset type 1 diabetes with ketoacidosis: A retrospective study from two Nigerian Teaching Hospitals

Abstract

Background/Aim:Community-acquired electrolyte disorders have been associated with poor prognosis following hospitalization and treatment for various illnesses. The aim of the study was to estimate the prevalence of abnormalities of serum sodium and potassium concentrations in patients with new-onset type 1 diabetes with ketoacidosis at presentation in the paediatric emergency departments of two Nigerian teaching hospitals. Method:A retrospective medical records review was performed on all paediatric patients with new-onset type 1 diabetes complicated by ketoacidosis seen in two Nigerian hospitals (University of Benin Teaching Hospital and Lagos University Teaching Hospital) over a period of 5 years. Information obtained included age at diagnosis, gender, presenting complaints and outcome (dead or alive). Data on serum electrolyte concentrations (sodium, potassium, chloride, bicarbonate) as well as blood glucose before initiation of fluid resuscitation and insulin therapy were extracted. The anion gap and effective osmolality were computed. Results:Overall, 25(53.2%; 95% Confidence interval, CI= 38.9-67.5) of the 47 patients had abnormalities in serum sodium, potassium or a combination of both. With regard to serum sodium, isolated abnormalities were found in 14(29.8%; 95% CI =16.7-42.9) of 47 patients. Hyponatremia occurred in 25.5% (95% CI=19.1-31.9) and hypernatremia occurred in 2.1% (95% CI = 0.01-4.2). Of the 47 patients, 10(21.3%; 95% CI =15.3-27.3) had isolated serum potassium abnormalities. The frequency of hypokalemia and hyperkaliemia were 8.5% (95% CI= 4.4-12.6) and 10.6%(95% CI= 6.6-15.1), respectively. The hypokalemia was severe (< 2.5mmol/L) in 2.1% of cases. The frequency of combined hyponatremia and hypokalemia was 2.1%. The mean anion gap was 18.6±0.6 (95% CI =18.4-18.8). The mean time for resolution of ketoacidosis was 2.8±0.6 days (95% CI= 2.6-3.0). Five (10.9%) of the 47 patients were toddlers (1 to 3 years old). Polyuria, weakness and anorexia were the key presenting complaints in toddlers with DKA. Of the 28 patients from UBTH, one (3.4%) died and the patient had severe mixed electrolyte disturbances (hyponatremia, hypokalemia and acidosis). Conclusion:At point of hospitalization for paediatric new-onset diabetes with ketoacidosis, disturbances in serum sodium and potassium concentrations were common. Polyuria, weakness and anorexia were the key presenting complaints in toddlers with DKA.

Keywords

• children
• diabetic ketoacidosis
• hyponatremia
• hypernatremia
• hypokalemia
• hyperkalemia
• toddlers