title: Rate and prediction of infection in children with diabetic ketoacidosis.
abstract: The purpose of this retrospective cohort study was to determine the rate and prediction of infection in children, < or = 21 years, with diabetic ketoacidosis (DKA). Over a 6-year period, 247 admissions were identified. There were 171 (69%) with no infection, 44 (17.8%) with presumed viral infection, and 32 (12.9%) with bacterial infection. The mean WBC for all patients was 17,519 ( +/- 9,582). 118 (50%) had leukocytosis as defined by a WBC > or = 15,000/mm3. WBC, differential, leukocytosis, as well as sex, temperature and new onset diabetes, were not significant predictors (P > .05) of bacterial infection. Bacterial infections were more common in children < or = 3 years of age (P = .03). There was a significant correlation of WBC with both pH (r = -0.59, P < .001) and bicarbonate (r = -0.43, P < .001). In conclusion, most children in DKA have no evidence of infection. Leukocytosis is common but most likely reflects the severity of DKA rather than the presence of infection.
authors.affiliation: Division of Emergency Medicine, Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: R G
authors.initials: RG
authors.lastname: Flood
authors.forename: V W
authors.initials: VW
authors.lastname: Chiang
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016883:Diabetic Ketoacidosis / Q000382:microbiology* / Q000821:virology*; D005260:Female; D006801:Humans; D007223:Infant; D007964:Leukocytosis / Q000382:microbiology / Q000821:virology; D008297:Male; D009511:New England / Q000453:epidemiology; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D014777:Virus Diseases / Q000175:diagnosis / Q000453:epidemiology*