Chloride as a Prognostic Factor in Children with Diabetic Ketoacidosis: A Retrospective Cohort Study

Abstract

Introduction: In the management of Diabetic Ketoacidosis (DKA), importance is given to electrolytes such as sodium and potassium, but not chloride. There is evidence that high chloride levels can lead to Acute Kidney Injury (AKI). However, chloride as a prognostic factor has not been thoroughly investigated. Aim: To evaluate the role of chloride as a prognostic factor in the treatment of children with DKA. Materials and Methods: This retrospective cohort study collected data from 22 children with severe DKA, aged under 14 years, admitted to the Department of Paediatrics, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, between January 2016 and October 2020. Data included demographic details, blood glucose, arterial blood gas, renal function tests, serum electrolytes at admission and at 24 hours, and outcome parameters. All children received regular monitoring and standard treatment as per the International Society for Paediatric and Adolescent Diabetes (ISPAD) guidelines. The children were divided into two groups: Recovery within 48 hours (Group-A) and more than 48 hours (Group-B). Electrolyte and renal parameters after 24 hours of treatment were compared. Univariate analysis was performed using Statistical Package for Social Sciences (SPSS) version 21.0. Student's t-test, Chisquare test, and odds ratio were used for statistical analysis. A p-value of <0.05 was considered significant. Results: Among the 22 children, 50% recovered within 48 hours, while the remaining half took more than 48 hours. A total of 13 had hyperchloraemia at 24 hours (59%). The mean serum chloride at 24 hours was 115.91 mmol/L in Group-B compared to 106.09 mmol/L in Group-A (p=0.0079*). Two developed AKI, requiring renal replacement therapy and ventilatory support, and eventually died. Conclusion: In the present study, children with severe DKA who developed hyperchloraemia after 24 hours of admission, following fluid resuscitation with 0.9% normal saline and subsequent standard treatment, took a longer time to recover.

Keywords

• acute kidney injury
• hyperchloraemia
• hyperchloraemic acidosis
• prognosis