Analysis of complications related to diabetic ketoacidosis in pediatric patients at a University Hospital: a cross-sectional study

Abstract

Objectives: Diabetic ketoacidosis is one of the main complications of type 1 diabetes mellitus and the leading cause of death among children and adolescents with the disease. The objective of this study was to characterize the cases of diabetic ketoacidosis treated in a University Hospital reference in pediatric endocrinology and identify their most frequent complications.

Methods: A cross-sectional descriptive study was carried out, based on the review of medical records of patients aged 0-16 years with a diagnosis of diabetic ketoacidosis treated between January 2016 and August 2020. Insulin therapy was performed subcutaneously as part of the hospital's protocol.

Results: Seventy-seven (77) admissions were analyzed and 55.8 % were diagnosed with a new case of type 1 diabetes. Adolescents (54.5 %) were the most affected. An increase of 90.9 % of cases between 2016 and 2020 was visualized. Severe DKA was more frequent in school-aged children. An increase in the dose of insulin was related to the severity of diabetic ketoacidosis. Hypokalemia was the most frequent complication. Cerebral edema occurred in 11.7 % of cases, and it was the cause of the only death, corresponding to a mortality rate of 1.3 %.

Conclusions: Rising DKA incidence aligns with global trends, with poor adherence driving cases in previously diagnosed adolescents. High rates of hypokalemia and cerebral edema were found, but with lower mortality, showing the effectiveness of subcutaneous insulin for treatment. Future studies should confirm findings, address adherence issues, and refine hydration, insulin dosing, and monitoring practices to reduce complications.

Keywords: Diabetic ketoacidosis; Pediatrics; Type 1 diabetes mellitus.

Figure 1

Frequency of mild, moderate, and severe cases by age range.