title: Ketoacidosis at onset of type 1 diabetes mellitus in children--frequency and clinical presentation.
abstract: BACKGROUND
  Since 1987, patients with newly diagnosed diabetes mellitus type 1 under 15 yr of age have been registered in Baden-Wuerttemberg (BW), Germany.
  
  
  OBJECTIVE
  Our aim was to describe the frequency and the clinical presentation of diabetic ketoacidosis (DKA) at onset of type 1 diabetes mellitus in children.
  
  
  METHODS
  All 31 pediatric departments in BW and one diabetes center participated in this study. Hospital records of 2121 children below 15 yr of age were examined retrospectively. DKA was defined as glucose > 250 mg/dL, pH < 7.30 or bicarbonate < 15 mmol/L and ketonuria. Statistical analysis was done after logarithmic transformation.
  
  
  RESULTS
  26.3% (n = 558) of all patients presented with DKA. The mean age of these patients was 7.9 yr. The frequency of DKA is higher in girls than in boys (28.9 vs. 23.8%; p = 0.0079). Those aged 0-4 yr suffered most frequently (p < 0.0001) from ketoacidosis (36.0%). The percentage of DKA in newly diagnosed cases was constant over 10 yr. 23.3% of all patients with DKA presented with an altered level of consciousness; 10.9% of these had clinical signs of coma. No deaths occurred. The proportion of ketoacidosis does not increase concurrently with the number of diabetes manifestations in winter.
  
  
  CONCLUSIONS
  The proportion of DKA in children with newly diagnosed diabetes mellitus is significant. In particular, children < 5 yr and girls face an increased risk. DKA may be the result of a particularly aggressive subtype of diabetes.
authors.affiliation: University of Tuebingen, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany. andreas.neu@med.uni-tuebingen.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Neu
authors.forename: Andre
authors.initials: A
authors.lastname: Willasch
authors.forename: Stefan
authors.initials: S
authors.lastname: Ehehalt
authors.forename: Regine
authors.initials: R
authors.lastname: Hub
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ranke
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000175:diagnosis*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012727:Sex Characteristics