A. Ehsasatvatan, A. Zolfigol and N. Javan (2026). Prevalence of prolonged QTc interval and its association with disease severity in pediatric diabetic ketoacidosis: a retrospective cross-sectional study in a tertiary care center. Journal of diabetes and metabolic disorders, 25(1), 83. https://doi.org/10.1007/s40200-026-01862-2

PubMed 41767432

[Abstract]
BACKGROUND: Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus in children, and is characterized by profound metabolic disturbances. Prolongation of the corrected QT (QTc) interval is a significant cardiac abnormality associated with increased risk of arrhythmias and sudden cardiac death. This study aimed to assess the prevalence of QTc prolongation and its correlation with DKA severity in pediatric patients.

METHODS: We conducted a retrospective cross-sectional study involving 100 children under 18 years of age who were admitted to Motahari Hospital in Urmia, Iran. The severity of DKA was determined using arterial blood gas analysis. QTc intervals were calculated from admission electrocardiograms and categorized as prolonged or normal. The relationship between QTc status and biochemical parameters, including arterial pH, serum bicarbonate (HCO₃⁻), and partial pressure of CO₂ (PCO₂)-was analyzed.

RESULTS: QTc prolongation was observed in 17% of the study population. Patients with prolonged QTc exhibited significantly lower arterial pH (6.96 ± 0.15) and serum bicarbonate (4.62 ± 2.26 mmol/L) compared to those with normal QTc (pH 7.09 ± 0.22, HCO₃⁻ 7.22 ± 3.53 mmol/L; p = 0.018 and p = 0.005, respectively). PCO₂ levels were lower in the prolonged QTc group (15.5 ± 5.95 mmHg vs. 20.10 ± 7.02 mmHg, p = 0.021). The QTc duration increased with DKA severity, and 27.5% of patients with severe DKA had prolonged QTc intervals.

CONCLUSION: QTc prolongation is relatively frequent in pediatric DKA and correlates strongly with disease severity. Early ECG monitoring may help identify high-risk patients and guide timely intervention to prevent serious cardiac complications.

CLINICAL TRIAL REGISTRATION: Clinical trial number: not applicable.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40200-026-01862-2.