Outcome of children with diabetic ketoacidosis treated with a modified protocol

Abstract

Introduction: The majority of children with moderate diabetic ketoacidosis (DKA) and all children with severe DKA should
be treated in a medical facility. This is unique issues that arise in DKA in the young. Aim: Study was undertaken to analyze
the outcome of children with DKA treated with a modified protocol. Materials and Methods: We have analyzed 35 patients
with DKA admitted in our Pediatric Intensive Care Unit. Patients were managed according to a modified protocol. Laboratory
parameters measured were blood glucose, urinary ketones, electrolytes, urea creatinine, and arterial blood gas. Results: Over
a period of 12 months, 35 patients of DKA are admitted, out of these, 10 (29%) were male and 25 (71%) were female. Age group
ranged between 4 months and 13 years with mean age of 5.63 years. Diabetes mellitus was newly diagnosed at presentation in
40% (14 cases) of cases, 43% (15 cases) of cases were due to non-compliance, and 17% (6 cases) were due to fever (stress). The
presenting most common symptoms were polyuria/polydipsia (68.5%). Most commonly observed clinical sign was 54.2% (19 cases)
had dehydration, majority of the cases (42%) presented in our institute are due to poor compliance. 40% of cases are newly
diagnosed. Of these newly diagnosed cases, 5.7% (2 cases) of cases who were infants, presented in severe respiratory distress,
thought to be severe bronchopneumonia had come out to be DKA. Out of 35 cases hospitalized, 32 cases (91.4%) recovered
without any complications of DKA. Average recovery time in these patients is 23.15 h. 2 cases died due to uncontrolled septicemia
despite good glucose control and stabilization of their ketoacidosis state. Conclusions: There should be high index of suspicion
necessary on the part of the clinician.