Diabetic ketoacidosis: predictors of outcome in a pediatric intensive care unit of a developing country.
OBJECTIVE
To study the outcome and predictors of mortality in children with diabetic ketoacidosis.


METHODS
Retrospective case series.


METHODS
Pediatric intensive care unit of an urban multiple-specialty teaching and referral hospital in north India.


METHODS
Sixty-eight patients with diabetic ketoacidosis treated between 1993 and 2000.


METHODS
Data were retrieved from case records with respect to patients' age; clinical features; osmolality at admission; blood glucose, serum potassium, and arterial pH at admission, 6 hrs, and 24 hrs; complications during the course of hospital stay; treatment; and outcome in terms of survival or death. Survivors and nonsurvivors were compared to determine the predictors of mortality.


RESULTS
The mean (sd) age of the study population was 6.9 (3.5) yrs (range, 0.5-12 yrs). Impaired consciousness (n = 45; 66%), rapid breathing (n = 41; 60%), and vomiting (n = 35; 51.4%) were common presenting symptoms. Thirty-two (50%) patients had clinically evident dehydration. Precipitating events identified were new-onset diabetes with sepsis (37%), new-onset diabetes alone (31%), insulin omission (15%), and infection with insulin omission (7%). The mean (sd) blood glucose, osmolality, and pH at admission were 473 (sd 184) mg/dL, 305 (sd 24) mOsm/L, and 7.08 (sd 0.1), respectively. Complications noted during treatment were hypokalemia (n = 28; 41%), hypoglycemia (n = 10; 15%), cerebral edema (n = 9; 13.2%), and pulmonary edema (n = 2; 3%). Nine (13.2%) patient died, with the causes of death being septic shock (n = 4), cerebral edema (n = 2), cerebral edema with pulmonary edema (n = 2), and hypokalemia with ventricular tachycardia (n = 1). Those who died were older, had higher osmolality and severe acidosis at admission, and had persistent hyperglycemia and acidosis at 6-12 hrs. On multiple logistic regression analysis, osmolality at admission was the most significant predictor of death.


CONCLUSIONS
Two thirds of children with diabetic ketoacidosis in our series had new-onset diabetes, and 13.2% died. Serum osmolality at admission was the most important predictor of death.
Jayashree
M
M
Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Singhi
Sunit
S
D017677:Age Distribution; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003906:Developing Countries; D016883:Diabetic Ketoacidosis / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D011237:Predictive Value of Tests; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D014505:Urban Population