title: Hypertension despite dehydration during severe pediatric diabetic ketoacidosis.
abstract: OBJECTIVE
  Diabetic ketoacidosis (DKA) may result in both dehydration and cerebral edema but these processes may have opposing effects on blood pressure. We examined the relationship between dehydration and blood pressure in pediatric DKA.
  
  
  METHODS
  A retrospective review was performed at Seattle Children's Hospital, Seattle, WA. Participants were hospitalized children less than 18 yr. Intervention(s) or main exposure was to patients with DKA (venous pH < 7.3, glucose > 300 mg/dL, HCO(3) < 15 mEq/L, and urinary ketosis). Dehydration was calculated as percent body weight lost at admission compared to discharge. Hypertension (systolic and/or diastolic blood pressure (DBP) percentile > 95%) was defined based on National Heart, Lung, and Blood Institute (NHLBI, 2004) nomograms and hypotension was defined as systolic blood pressure (SBP) <70 + 2 [age].
  
  
  RESULTS
  Thirty-three patients (median 10.9 yr; range 10 months to 17 yr) were included. Fifty-eight percent of patients (19/33) had hypertension on admission before treatment and 82% had hypertension during the first 6 h of admission. None had admission hypotension. Hypertension 48 h after treatment and weeks after discharge was common (28 and 19%, respectively). Based on weight gained by discharge, 27% of patients had mild, 61% had moderate, and 12% presented with severe dehydration.
  
  
  CONCLUSIONS
  Despite dehydration, most children admitted with severe DKA had hypertension.
authors: Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
authors: Kristina H
authors: KH
authors: Deeter
authors: Joan S
authors: JS
authors: Roberts
authors: Heidi
authors: H
authors: Bradford
authors: Todd
authors: T
authors: Richards
authors: Dennis
authors: D
authors: Shaw
authors: Kenneth
authors: K
authors: Marro
authors: Harvey
authors: H
authors: Chiu
authors: Catherine
authors: C
authors: Pihoker
authors: Anne
authors: A
authors: Lynn
authors: Monica S
authors: MS
authors: Vavilala
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D001929:Brain Edema / Q000209:etiology*; D002648:Child; D003681:Dehydration / Q000209:etiology*; D016883:Diabetic Ketoacidosis / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D007223:Infant; D008297:Male; D012189:Retrospective Studies