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Identifier 000431634
Title Διαβητική κετοξέωση στην παιδική ηλικία
Alternative Title Diabetic ketoacidosis in childhood
Author Μουδατσάκη, Μαρία
Thesis advisor Ηλία, Σταυρούλα
Reviewer Μπριασούλης, Γεώργιος
Μαμουλάκης, Δημήτρης
Βαπορίδη, Αικατερίνη
Abstract Background Diabetic ketoacidosis (DKA) is an acute metabolic disorder that occurs in conditions of insulin deficiency or over-secretion of counterregulatory hormones. It is characterized by hyperglycemia, metabolic acidosis with increased anion gap and dehydration. It is not a rare condition in children with diabetes mellitus (DM) and is associated with serious and potentially life-threatening consequences. Management of patients with DKA and the correlation of intravenous fluids with the risk of developing cerebral edema is highly debated. There are differences even among the main therapeutic guidelines. To our knowledge there are no registered data of DKA in children in Greece. The main point of interest of ongoing studies is the need to correlate parameters of acid-base balance with clinical markers of severity and outcome, mainly concerning the monitoring of the rate of correction of DKA and its complications, and their clinical utility as predictive indicators. Objective The aim of this study is to investigate the epidemiologic and clinical data of patients admitted in Pediatric Intensive Care Unit (PICU) at the University Hospital of Heraklion, Crete, with DKA, to assess the severity of DKA, the administration of fluids and to determine clinical and laboratory markers and their correlation with late or early correction of acidosis, the complications, the duration of hospitalization, and the outcome. Methods This is a single center, retrospective study including all children under the age of 18 years old with newly diagnosed or known T1DM, presented with DKA and admitted in PICU at the University Hospital of Heraklion during the years 2004 and 2020. For the results analysis, the children were further divided into two comparison groups according to: a) The severity of DKA characterized by the degree of acidosis (severe DKA – pH <7.1 vs moderate DKA – pH &ge;7.1) based on NICE classification (2020) and b) The history of T1DM (newly diagnosed vs known T1DM). The resolution of DKA was examined by four parameters: pH, bicarbonate levels, onset of oral intake and subcutaneous insulin. The outcome of DKA was examined by three parameters: length of hospital stay, length of PICU stay and manifestation of complications during treatment. Results Out of 1969 patients admitted in PICU during the last 16 years, only 2.5% of them concerned DKA cases (N=49). The prevalence of DKA at the diagnosis of T1DM was 84%. There was no difference in sex distribution. Cerebral edema and death were reported in only one patient. Patients with new onset T1DM had more severe acidosis with pH <7.1, in contrast with children with known T1DM, who at high percentage presented with moderate acidosis with pH &ge;7.1 (p=0.01). Most children received one or no initial fluid bolus of NaCl 0.9%. No difference was noted regarding administration of fluid boluses in relation with the severity of DKA, as well as with the outcome. The correlation between clinical severity measured with PRISM and age showed that the younger the age of presentation of DKA at diagnosis of T1DM the more severe are the clinical manifestations, while in children with known T1DM severity rises with age. Children with positive family history of T1DM in relatives of first or second degree or positive family history of T2DM presented with more severe clinical status in PICU (p=0.034). Concerning the time of correction of pH >7.3 and bicarbonate levels >15 mmol/L, there was a positive correlation between them (p<0.001) but also a time difference, with earlier pH restoration (mean=6.06 hours). Anion gap was not associated with the severity of DKA. Among the children with pH at admission <7.1 and those with pH &ge;7.1, a time difference existed between the correction of pH >7.3 (p=0.007) and bicarbonate levels >15 mmol/L (p=0.001). More specifically, in more severe acidosis the resolution of DKA was delayed. The same also occurred in this group, with the onset of oral intake (p=0.004). The length of PICU stay was associated with the severity of DKA, with the longest time of stay matching with patients with pH at admission <7.1 (p<0.008). The younger the age, irrespective of the severity of DKA, the longer the hospitalization was (p<0.001). Conclusion Upon diagnosis of T1DM and mainly in younger children, the DKA is more severe. Children with established T1DM exhibit more severe DKA during adolescence. The more severe the degree of acidosis, the longest is the time of restoration of DKA in these children. The length of hospital stay is prolonged in toddlers and pre- school aged children. Correction of acidosis takes place within the first 24 hours of hospitalization and oral intake and subcutaneous administration of insulin begin during the second day, as well as the discharge from PICU. The rate of complications noted is low.
Language Greek
Subject Diabetesmellitus
Health-related quality of life
Longitudinal study
ΜΕΘ παίδων
Σακχαρώδης διαβήτης τύπου 1
Issue date 2020-08-05
Collection   Faculty/Department
  Type of Work
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