Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec 6;36(2):174-178.
doi: 10.1515/jpem-2022-0457. Print 2023 Feb 23.

Outcomes of children with severe diabetic ketoacidosis managed outside of a pediatric intensive care unit

Zoe T Raleigh  1 , Zachary A Drapkin  2 , Dania M Al-Hamad  1 , Krishnamallika Mutyala  1 , Jasmine R Masih  1 , Vandana S Raman  1
Affiliations

Outcomes of children with severe diabetic ketoacidosis managed outside of a pediatric intensive care unit

Zoe T Raleigh et al. J Pediatr Endocrinol Metab. .

Abstract

Objectives: Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes. Our objective was to determine if children with severe DKA without alteration in mental status can be managed safely on a general children's medical unit.

Methods: Single center retrospective study of 191 patient encounters among 168 children admitted to the children's medical unit (CMU) at Primary Children's Hospital between 2007 and 2017 with severe DKA (pH <7.1 and/or bicarbonate <5 mmol/L). Chart review identified complications including death, transfer to the intensive care unit (ICU), incidence of cerebral edema, and hypoglycemia. We compared patients requiring ICU transfer with those who did not with respect to demographics, laboratory findings at presentation, therapeutic interventions, length of stay, and cost.

Results: Of 191 patient encounters, there were 0 deaths (0%, 95% CI 0-2.4%), 22 episodes of alteration of mental status concerning for developing cerebral edema (11.5%, 95% CI 7.7-16.9%), 19 ICU transfers (10%, 95% CI 6.4-15.1%), and 7 episodes of hypoglycemia (3.7%, 95% CI 1.6-7.5%). ICU transfer was associated lower initial pH (7.03 ± 0.06 vs. 7.07 ± 0.07, p<0.05), increased length of stay (3.0 ± 0.8 vs. 2.2 ± 0.9 days, p<0.05), and increased cost of hospitalization (mean ± SD $8,073 ± 2,042 vs. $5,217 ± 1,697, p<0.05).

Conclusions: The majority of children with severe DKA without alteration in mental status can be managed safely on a medical unit. Implementing a pH cutoff may identify high-risk patients that require ICU level of care.

Keywords: cerebral edema; critical care; diabetic ketoacidosis; hypoglycemia.

PubMed Disclaimer

References

    1. Scibilia, J, Finegold, D, Dorman, J, Becker, D, Drash, A. Why do children with diabetes die? Eur J Endocrinol 1986;113:S326–33. https://doi.org/10.1530/acta.0.112S326 . - DOI
    1. Edge, JA, Ford-Adams, ME, Dunger, DB. Causes of death in children with insulin dependent diabetes 1990–96. Arch Dis Child 1999;81:318–23. https://doi.org/10.1136/adc.81.4.318 . - DOI
    1. McNally, PG, Hearnshaw, JR, Raymond, NT, Botha, JL, Burden, ML, Burden, AC, et al.. Trends in mortality of childhood-onset insulin-dependent diabetes mellitus in leicestershire: 1940-1991. Diabet Med 1995;12:961–6. https://doi.org/10.1111/j.1464-5491.1995.tb00406.x . - DOI
    1. Muir, AB, Quisling, RG, Yang, MCK, Rosenbloom, AL. Cerebral edema in childhood diabetic ketoacidosis: natural history, radiographic findings, and early identification. Diabetes Care 2004;27:1541–6. https://doi.org/10.2337/diacare.27.7.1541 . - DOI
    1. Rosenbloom, AL. Intracerebral crises during treatment of diabetic ketoacidosis. Diabetes Care 1990;13:22–33. https://doi.org/10.2337/diacare.13.1.22 . - DOI

LinkOut - more resources