Abstract
Objective: Our aim is to determine the severity, clinical features, presence of complications and outcome differences
in previously diagnosed and newly diagnosed Type 1 Diabetes Mellitus (T1DM) patients followed up with diabetic
ketoacidosis (DKA) in the pediatric intensive care unit.
Material and Methods: This study was conducted retrospectively in a 32-bed tertiary pediatric intensive care unit.
The patients were divided into newly diagnosed and previously diagnosed T1DM. All collected data were compared
between groups.
Results: 107 patients were included into the study. Most of the patients were male (51.4%). Most of the newly diagnosed
patients were in the 6-10 age group (49.2%). When patient complaints were evaluated before admission, the complaint
of nausea was statistically higher in previously diagnosed DM patients (p=0.041). The complaints of fatigue, polyuria,
polydipsia, and weight loss were statistically higher in newly diagnosed Type-1 DM (p value 0.001, 0.001, 0.001,
0.001, respectively). Hypokalemia was statistically higher in the newly diagnosed DM group during diabetic ketoacidosis
treatment (p=0.015). Although there was no difference between intensive care durations, total hospitalization days were
statistically longer in newly diagnosed DM patients (p values 0.145, 0.007, respectively). All patients survived.
Conclusion: The school age group was the most common age group in newly diagnosed T1DM. While polyuria,
polydipsia and weight loss are common in newly diagnosed Diabetic Ketoacidosis patients; Vomiting was common in
diabetic ketoacidosis patients with previous diagnosis. Trainings, national advertisements, etc. should be done to increase
the knowledge level of patients and families about these symptoms and the disease.
Keywords: children, diabetic ketoacidosis, intensive care
References
- Referans1.) Lopes CLS, Pinherio PP, Barbarena LS, Eckert GU. Diabetic ketoacidosis in a pediatric intensive care unit. J Pediatr (Rio J).2017; 93(2):179-184.
- Referans2.) Ampt A, Gemert TV, Craig ME, Donaghue KC, Lain SB, Nassar N. Pediatric Diabetes.2019;20(7):901-908.
- Referans3.) Jawaid A, Sohaila A, Mohammed N, Rabbani U. Frequency, clinical characteristics, biochemical findings and outcomes of DKA at the onset of type-1 DM in young children and adolescents living in a developing country-an experience from pediatric emergency department. J Pediatr Endocrinol Metab. 2019;32(2):115-119.
- Referans4.)Pozo PD, Aranguiz D, Cordova G, Scheu C, Valle P, Cerda J, Garcia H, Hodgson MI, Castillo A. Rev Chil pediatr.2018;89(4):491-498.
- Referans5.)Wolfsdorf JI, Glaser N, Agus M et al. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatric Diabetes. 2018; 19 (Suppl. 27): 155–177.
- Referans6.)Lee HJ, Yu HW, Jung HW et all.Factors Associated with the Presence and Severity of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Korean Children and Adolescents.J Korean Med Sci 2017; 32: 303-309.
- Referans7.) Esen I, Okdemir D. The Frequency of Ketoacidosis and Associated Factors at the diagnosis of Type 1 Diabetes in Turkish Children: A Single-Center Experience and Literature Review. J Pediatr Res.2021;8(3):309-19.
- Referans8.) Choleau C, Maitre J, Pierucci AF et al. Ketoacidosis at diagnosis of type 1 diabetes in French children and adolescents. Diabetes&Metabolism:2014;40:135-142.
- Referans9.) Aras B, Akın A, Yıldırım R ve ark. Tip 1 Diyabetes Mellituslu Cocuklarda tanı anındaki Klinik ve Laboratuar Bulgularının Değerlendirilmesi. Dicle Med J(2019);46:11-17.
- Referans10.) Ongun EA, Celik N. Risk Factors associated with resolution of diabetic ketoacidosis in pediatric critical care units. Cumh. Med.Journal.2019;41:42-50.
- Referans11.) Koyuncu E, Saglam H, Tarim O. Diyabetik Ketoasidozla Başvuran Çocuk Olguların Değerlendirilmesi. J Curr Pediatr.2016;14:116-23.
- Referans12.) Bayoglu DS, Akıcı N, Bayoglu V ve ark. Tip 1 Diyabetli Çocukların Klinik ve Epidemiyolojik Özellikleri. Haydarpasa Numune Egitim ve Arastirma Hastanesi Tıp Dergisi.2014;54:87-92.
- Referans13.) Levy-Marchal C, Patterson CC, Green A, Europe EASG, Diabetes. Geographical variation of presentation at diagnosis of type I diabetes in children:the EURODIAB study.European and Diabetes. Diabetologia 2001;44(Suppl 3):B75-80.doi:10.1007/pl00002958.
- Referans14.) Acar S, Goren Y, Paketci A ve ark. Tip 1 Diabetes Mellitus Olgularının Tanı Anindaki Diyabetik Ketoasidoz Sıklığının değişimi:On Beş Yıllık Tek Merkez Deneyimi. J Pediatr Res;2017.4.143-8.
- Referans15.) Szypowska A, Ramotowska A, Grzechnik-Gryziak M et al. High frequency of Diabetic Ketoacidosis in Children with Newly Diagnosed Type 1 Diabetes. Journal of Diabetes Research.2016:9582793. doi: 10.1155/2016/9582793.
- Referans16.) Demir K, Buyukinan M, Dizdarer C ve ark. Tip 1 Diyabetli çocuklarda tanıda Diyabetik Ketoasidoz Sıklığı ve ilişkili faktörler. Guncel Pediatri Dergisi.2010;8:52-55.