Frequency of complications of DKA in children admitted in PICU.

OBJECTIVE

Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening complication of diabetes mellitus in children, frequently requiring admission to the pediatric intensive care unit (PICU). The treatment of diabetic ketoacidosis has long been problematic, divisive, and fraught with uncertainty. Understanding the frequency of associated complications is essential for improving clinical management and outcomes. The aim of this study was to determine the frequency and severity of DKA in pediatric patients admitted to the PICU, to identify the pattern of electrolyte abnormalities, and to evaluate the association between DKA severity, electrolyte disturbances, and the risk of cerebral injury and other acute complications.

METHODS

This cross-sectional retrospective study was conducted on pediatric patients aged 1 month to 16 years admitted with DKA to the PICU of a tertiary referral center between December 2018 and December 2022. DKA was defined according to ISPAD criteria. Data on demographic characteristics, laboratory findings, and clinical outcomes were extracted from medical records. The frequency of complications, including electrolyte disturbances, cerebral injury, and acute kidney injury (AKI), was evaluated.

RESULTS

A total of 161 patients were included, with a mean age of 8.22 ± 4.08 years. The most common electrolyte abnormality was hypophosphatemia (60.9%), followed by hypokalemia (50.9%) and hyponatremia (46.6%). Hypernatremia and hyperkalemia were observed in 15.5% and 19.3% of patients, respectively. Cerebral injury occurred in 8.1% of patients, while AKI was observed in 3.7%. Patients with severe DKA had a significantly higher risk of cerebral injury compared to those with moderate DKA. Hypernatremia was also associated with an increased risk of cerebral injury.

CONCLUSION

Complications of DKA, particularly electrolyte disturbances and cerebral injury, are relatively common among children admitted to the PICU. Severe DKA and hypernatremia are associated with a higher risk of cerebral injury. Early recognition and careful management of these complications are crucial to improving patient outcomes.