M. Chumięcki, Z. Prokopowicz, R. Deja and P. Jarosz-Chobot (2013). [Frequency and clinical manifestation of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes]. Pediatric endocrinology, diabetes, and metabolism, 19(4), 143-7.

PubMed 25612814

[Abstract]
INTRODUCTION: Diabetic ketoacidosis (DKA) is still the most dangerous acute complication of type 1 diabetes mellitus (T1DM). It is a life-threatening condition requiring intensive treatment. DKA may be the first symptom of previously undiagnosed diabetes, especially in children.

AIM OF THE STUDY: Assessment of the incidence and clinical manifestation of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes.

MATERIAL AND METHODS: We analyzed 535 medical files of children (aged 9 months to 17 years, mean age 4.41-9.96, 261 girls (48%)) hospitalized from 2006 to 2009 because of the newly diagnosed type 1 diabetes mellitus. DKA was diagnosed (according to ISPAD) in children with pH <7.3, blood glucose level >11 mmol/L (>200 mg/dL) and/or blood concentration of bicarbonate <15 mmol/L with ketonuria. Severe DKA was diagnosed in children with pH <7.2.

RESULTS: DKA was diagnosed in 123 patients (23%) (63 girls (51%)). The mean age of children with DKA was significantly lower than the age of the children without DKA (9.05-4.45 vs 9.48-4.39 years; p<0.001). Mean pH was 7.21-1.03 (min. 6,82; max. 7,30). In 32.5% of children with DKA severe ketoacidosis (pH -7.2) was observed. The prevalence of acidosis was higher in the 0-4 age group compared to children over 4 years (28 vs. 22%, p<0.001). Neither sex, nor symptoms duration were associated with the development of DKA. Polyuria (95%), polydipsia (95%), weight loss (85%) and abdominal pain (50%) were the most common symptoms reported by patients.

CONCLUSIONS: Despite the typical symptomatology of type 1 diabetes mellitus, about 1/4 of newly diagnosed diabetes in children is accompanied by ketoacidosis. The risk of acidosis is greater in younger children.