Spectrum of Complications in Children with Moderate to Severe DKA Admitted in Pediatric Intensive Care Unit of a Tertiary Care Hospital

Abstract

Introduction: Diabetic Ketoacidosis (DKA) is the major source of mortality and morbidity in type 1 Diabetes Mellitus. Cautious fluid resuscitation, insulin and electrolyte replacement along with observation for complications is the mainstay of treatment. Early identification of complications lead to better management and outcome. Objective: To find out the complications of moderate to severe DKA in pediatric patients admitted in Pediatric Intensive Care Unit (PICU). Methods: Cross-sectional Study was conducted in PICU of University of Child Health Sciences & The Children’s Hospital, Lahore from Jan, 2015 to Dec, 2018.Data was collected from retrospective records of patients admitted in PICU. All patients with moderate/severe DKA were included. Patients with developmental delay were excluded. Data was analyzed using SPSS version 25. Chi-square test was used to find out p-value. Results: A total of 152 patients with moderate/severe DKA were included in the study, having mean age of 7.86 ± 4.06 years. Most patients 42% (n=64) were more than 10 years of age. Mean weight of the children was 19.89 ± 8.70 kg. Majority 59% (n= 89) were of new onset diabetes. Severe DKA was seen in 74% while moderate DKA in 26% patients. The complications seen were: hypokalemia 33% (n=50), cerebral edema 28% (n=42), hypernatremia 18% (n=27), hyponatremia 8% (n=12) and acute kidney injury (AKI) in 7% (n=11). Survival rate was 85% while mortality rate was 15%. Conclusion: Hypokalemia and cerebral edema were the most common complications observed. Complications were more common in those patients who presented with DKA in first presentation. Key words: complications, DKA severity, children, PICU.

Keywords

• Complications, DKA severity, children, PICU.