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. 2022 May 5;58(5):638.
doi: 10.3390/medicina58050638.

Epidemiologic Characteristics of Children with Diabetic Ketoacidosis Treated in a Pediatric Intensive Care Unit in a 10-Year-Period: Single Centre Experience in Croatia

Kristina Lah Tomulić  1   2 , Lucija Matko  2 , Arijan Verbić  1 , Ana Milardović  1   2 , Srećko Severinski  2   3 , Ivana Kolić  3 , Kristina Baraba Dekanić  2   3 , Senada Šerifi  2   3 , Ivona Butorac Ahel  2   3
Affiliations

Epidemiologic Characteristics of Children with Diabetic Ketoacidosis Treated in a Pediatric Intensive Care Unit in a 10-Year-Period: Single Centre Experience in Croatia

Kristina Lah Tomulić et al. Medicina (Kaunas). .

Abstract

Background and Objectives: The incidence of severe and moderate forms of DKA as the initial presentation of type 1 diabetes mellitus (T1D) is increasing, especially during the COVID-19 pandemic. This poses a higher risk of developing cerebral edema as a complication of diabetic ketoacidosis (DKA), as well as morbidity and mortality rates. The aim of this study was to determine the trend and clinical features of children treated in the last 10 years in the Pediatric Intensive Care Unit (PICU) due to the development of DKA. Materials and Methods: This retrospective study was performed in the PICU, Clinical Hospital Centre Rijeka, in Croatia. All children diagnosed with DKA from 2011-2020 were included in this study. Data were received from hospital medical documentation and patient paper history. The number of new cases and severity of DKA were identified and classified using recent International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines. Results: In this investigation period, 194 children with newly diagnosed T1D were admitted to our hospital: 58 of them were treated in the PICU due to DKA; 48 had newly diagnosed T1D (48/58); and ten previously diagnosed T1D (10/58). DKA as the initial presentation of T1D was diagnosed in 24.7% (48/194). Moderate or severe dehydration was present in 76% of the children at hospital admission. Polyuria, polydipsia, and Kussmaul breathing were the most common signs. Three patients (5.2%) developed cerebral edema, of whom one died. Conclusions: During the investigation period a rising trend in T1D was noted, especially in 2020. About one quarter of children with T1D presented with DKA at initial diagnosis in western Croatia, most of them with a severe form. Good education of the general population, along with the patients and families of children with diabetes, is crucial to prevent the development of DKA and thus reduce severe complications.

Keywords: children; diabetic ketoacidosis; epidemiology; pediatric intensive care.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Number of children with newly diagnosed type 1 diabetes in Department of Pediatrics (Clinical Hospital Centre Rijeka, Croatia) in 2011–2020, and number of children with diabetic ketoacidosis at admission. Legend: T1D—type 1 diabetes; DKA—diabetic ketoacidosis.
Figure 2
Figure 2
Number of children with diabetic ketoacidosis admitted in Pediatric Intensive Care Unit in the period 2011–2020, divided by age groups.Legend: T1D—type 1 diabetes; DKA—diabetic ketoacidosis.
Figure 3
Figure 3
Number and percentage of children with diabetic ketoacidosis admitted in Pediatric Intensive Care Unit in the period 2011–2020, divided by severity of acidosis. Legend: DKA—diabetic ketoacidosis.
Figure 4
Figure 4
Average changes in blood glucose concentration (a), pH values (b), bicarbonate concentrations (c), and carbon dioxide partial pressure (d), for the children with diabetic ketoacidosis during the first 24 h of hospitalization in the Pediatric Intensive Care Unit. Legend: HCO3− bicarbonate concentration; pCO2—partial pressure of carbon dioxide.
See this image and copyright information in PMC

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