Clinical profile of children with diabetic ketoacidosis and related cerebral edema in a tertiary care hospital from Southern Kerala

Abstract

Objective: To study the clinical profile of children admitted with diabetic ketoacidosis (DKA) in the pediatric intensive care unit (PICU) of a tertiary care teaching hospital. To assess the risk factors for the development of cerebral edema in children with DKA. Methods: This retrospective case review was conducted in the PICU of a tertiary care teaching hospital. Details of children admitted with DKA during the period from August 2012 to November 2017 were collected with respect to clinical features, lab parameters, management, and outcome. The characteristics of children with and without cerebral edema were compared. The data were then analyzed statistically using SPSS software. Results: Among the 51 cases analyzed 66.7% were females and 35.3% were newly detected cases. 51.5% of the previously diagnosed and 50% of the newly detected subjects had an infection as the precipitating event. Vomiting was the most common clinical presentation (64.7%). Mean time taken for acidosis correction was 22.65 h. 12 patients (23.53%) developed cerebral edema during the course of treatment. Neurologic deterioration developed at a median of 6 h (range 1.5–36 h) after the initiation of treatment. An increased incidence of cerebral edema was found in patients who received excess fluid boluses before starting insulin treatment (p=0.02) and newly detected cases (p=0.037). In those who developed cerebral edema the mean blood sugar value at admission was found to be significantly higher (p=0.013). No deaths or neurological sequelae were reported. Conclusions: Infections are an important precipitating factor for DKA. A significant proportion of children developed cerebral edema during treatment. New cases, excess intravenous fluid boluses, high mean blood sugar at admission, and bicarbonate administration were identified as risk factors for cerebral edema.