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Randomized Controlled Trial
. 2020 Aug:223:156-163.e5.
doi: 10.1016/j.jpeds.2020.04.066. Epub 2020 May 6.

Hypertension during Diabetic Ketoacidosis in Children

Andrew DePiero  1 , Nathan Kuppermann  2 , Kathleen M Brown  3 , Jeff E Schunk  4 , Julie K McManemy  5 , Arleta Rewers  6 , Michael J Stoner  7 , Leah Tzimenatos  8 , Aris Garro  9 , Sage R Myers  10 , Kimberly S Quayle  11 , Jennifer L Trainor  12 , Maria Y Kwok  13 , Lise E Nigrovic  14 , Cody S Olsen  4 , T Charles Casper  4 , Simona Ghetti  15 , Nicole S Glaser  16 ; Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group
Affiliations
Randomized Controlled Trial

Hypertension during Diabetic Ketoacidosis in Children

Andrew DePiero et al. J Pediatr. 2020 Aug.

Abstract

Objectives: To characterize hemodynamic alterations occurring during diabetic ketoacidosis (DKA) in a large cohort of children and to identify clinical and biochemical factors associated with hypertension.

Study design: This was a planned secondary analysis of data from the Pediatric Emergency Care Applied Research Network Fluid Therapies Under Investigation in DKA Study, a randomized clinical trial of fluid resuscitation protocols for children in DKA. Hemodynamic data (heart rate, blood pressure) from children with DKA were assessed in comparison with normal values for age and sex. Multivariable statistical modeling was used to explore clinical and laboratory predictors of hypertension.

Results: Among 1258 DKA episodes, hypertension was documented at presentation in 154 (12.2%) and developed during DKA treatment in an additional 196 (15.6%), resulting in a total of 350 DKA episodes (27.8%) in which hypertension occurred at some time. Factors associated with hypertension at presentation included more severe acidosis, (lower pH and lower pCO2), and stage 2 or 3 acute kidney injury. More severe acidosis and lower Glasgow Coma Scale scores were associated with hypertension occurring at any time during DKA treatment.

Conclusions: Despite dehydration, hypertension occurs in a substantial number of children with DKA. Factors associated with hypertension include greater severity of acidosis, lower pCO2, and lower Glasgow Coma Scale scores during DKA treatment, suggesting that hypertension might be centrally mediated.

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Figures

Figure 1.
Figure 1.
Patient Inclusion in the PECARN FLUID Study and Current Analysis.
Figure 2.
Figure 2.
Distribution of blood pressure and heart rate z-scores.
See this image and copyright information in PMC

References

    1. Sottosanti M, Morrison GC, Singh RN, Sharma AP, Fraser DD, Alawi K, et al. Dehydration in children with diabetic ketoacidosis: a prospective study. Arch Dis Child. 2012;97:96–100. - PubMed
    1. Deeter KH, Roberts JS, Bradford H, Richards T, Shaw D, Marro K, et al. Hypertension despite dehydration during severe pediatric diabetic ketoacidosis. Pediatr Diabetes. 2011;12:295–301. - PMC - PubMed
    1. Bin Salleh H, Mujawar QM. Hypertension in severe pediatric diabetic ketoacidosis: case report and review of literature. Pediatr Emerg Care. 2013;29:82–3. - PubMed
    1. Edge JA, Hawkins MM, Winter DL, Dunger DB. The risk and outcome of cerebral oedema developing during diabetic ketoacidosis. Arch Dis Child. 2001;85:16–22. - PMC - PubMed
    1. Glaser N, Barnett P, McCaslin I, Nelson D, Trainor J, Louie J, et al. Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. N Engl J Med. 2001;344:264–9. - PubMed

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