title: Predictors of altered sensorium at admission in children with diabetic ketoacidosis.
abstract: OBJECTIVE
  To predict factors causing altered sensorium at admission in children with diabetic ketoacidosis (DKA).
  
  
  METHODS
  This retrospective study was done on 139 children with DKA who presented to Pediatric Emergency of a tertiary care hospital between January 2008 and November 2012. The case records were reviewed and information regarding personal details, clinical features, biochemical parameters and outcome was recorded. Statistical analyses were performed in small STATA version 12. Variables associated with altered sensorium in bivariate analysis (P < 0.05) were selected for inclusion in the multivariable logistic regression model.
  
  
  RESULTS
  Mean age was 8.04 ± 4.1 y; Male: Female ratio 0.75:1. The newly diagnosed diabetics were 54.6 % whereas rest were known diabetics. Eighty one percent children in severe DKA, 63 % moderate DKA and 18 % mild DKA had altered sensorium at admission. Univariate analysis revealed significant P values (P < 0.05) for pH and degree of dehydration. Results of final multivariate logistic regression revealed significant P values for pH (for pH 7.1-7.2, AOR-5.47, 95 % CI-1.24-24.1, P = 0.025 and for pH <7.1, AOR-14.19, 95 % CI - 4.13-48.7, P = 0.001) using pH >7.2 as the reference category.
  
  
  CONCLUSIONS
  Alteration in sensorium in children at initial admission with DKA is associated to low blood pH. ROC curve suggested good discrimination of pH for prediction of altered sensorium. The exact pathophysiologic mechanism of how low pH alters sensorium in DKA is still unknown and requires further studies.
authors.affiliation: Department of Pediatrics, Division of Pediatric Intensive Care and Emergency, Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi, 110001, India.
authors.forename: Viswas
authors.initials: V
authors.lastname: Chhapola
authors.forename: Sandeep Kumar
authors.initials: SK
authors.lastname: Kanwal
authors.forename: Obeid Mohammed
authors.initials: OM
authors.lastname: Shafi
authors.forename: Virendra
authors.initials: V
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003244:Consciousness Disorders / Q000209:etiology*; D016883:Diabetic Ketoacidosis / Q000150:complications*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007194:India; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index