Predisposing factors,Complications and Prognosis of the Patients with Diabetic Ketoacidosis Admitted to Zanjan Hospitals

Background and Objective: Diabetic ketoacidosis is one of the most common and life threatening complications in children with diabetes mellitus. The aim of this study was to evaluate predisposing factors, complications and prognosis of the patients with diabetic ketoacidosis admitted to Zanjan hospitals. Materials and Methods: The records of patients with DKA admitted to Mousavi and Vali-e Asr Hospitals of Zanjan city from ۲۰۰۶ to ۲۰۱۱ were studied. The presenting complaints along with laboratory results were collected and analyzed. Results: This study was carried out on fifty one patients with diabetic ketoacidosis. The mean age of children was ۶.۶±۳.۹ years. The most frequent symptoms were nausea and vomiting and the most frequent signs were dehydration (۹۴.۱%) and tachypnea (۸۸.۲%). Regarding laboratory results, ۴۹% of patients showed hypokalemia, ۲۵.۵% hypoglycemia, ۱۷.۶% hyponatremia, ۱۱.۸% hypernatremia, and ۹.۸% hyperkalemia. Finally, ۴۸ patients were discharged while ۳ patients died two of whom were died due to cerebral edema. Conclusion: Cerebral edema was the major mortality factor in our study. Therefore, prevention and treatment of cerebral edema is recommended. References ۱- Graham BB, Keniston A, Gajic O, et al. Diabetes mellitus does not adversely affect outcomes from a critical illness. Care Med. ۲۰۱۰ ۳۸: ۱۶-۲۴. ۲- Berry D, Melkus GD. Epidemiologic perspectives of risk for developing diabetes and diabetes complications. Nurse Clin North Am. ۲۰۰۶ ۴۱: ۴۸۷-۹۸. ۳- Orlowski JP, Cramer CL, Fiallos MR. Diabetic ketoacidosis in the pediatric ICU. Pediatr Clin North Am. ۲۰۰۸ ۵۵: ۵۷۷-۸۷. ۴- Razavi Z. Frequency of ketoacidosis in newly diagnosed type ۱ diabetic children. Oman Med J. ۲۰۱۰ ۲۵: ۱۱۴-۱۷. ۵- Agus MS, Wolfsdorf JI. Diabetic ketoacidosis in the pediatric ICU. Pediatr Clin North Am. ۲۰۰۵ ۵۲: ۱۱۴۷-۶۳. ۶- Lone SW, Siddiqui EU, Muhammed F, Atta I, Ibrahim MN, Raza J. Frequency, clinical characteristics and outcome of diabetic ketoacidosis in chidren with type-۱ diabetes at a tertiary care hospital. JPMA. ۲۰۱۰ ۶۰: ۷۲۵-۹. ۷- Rewers A, Chase HP, Mackenzie T, et al. Predictors of acute complications in children with type ۱ diabetes. JAMA. ۲۰۰۲ ۲۸۷: ۲۵۱۱-۸. ۸- Sheikholeslami H, Ziaee A, Shariatmadari M, Evaluation of clinical manifestation, laboratory data and precipitating factors in patients with diabetic ketoacidosis in educational and medical care center of Booali Sina in Ghazvin (۱۹۹۹-۲۰۰۴). J Birjand Unive Med Sci. ۲۰۰۸: ۶۰-۶۴. ۹- Jayashree M,Singhi S. Diabetic ketoacidosis: predictors of outcome in a pediatric intensive care unit of a developing country. Pdiatr Crit Care Med. ۲۰۰۴ ۵: ۴۹۲-۳. ۱۰- Marcin JP, Glaser N, Barnett P, McCaslin I, Nelson D, Trainor J. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. Pediatr. ۲۰۰۲ ۱۴۱: ۷۹۳-۷. ۱۱- Jahagirdar RR, Khadilkar RR, Khadilkar AV, Lalwani SK. Management of diabetic ketoacidosis in PICU. Indian J Pediatr. ۲۰۰۷ ۷۴: ۵۵۱-۴. ۱۲- Lawrence SE. Population-based study of incidence and risk factors for cerebral edema in pediatric diabetic ketoacidosis. J Pediatr. ۲۰۰۵ ۱۴۶: ۶۸۸-۹۲. ۱۳- Edge JA, Hawkins MM, Winter DL, Dunger DB. The risk and outcome of cerebral oedema developing during diabetic ketoacidosis. Arch Dis Cild. ۲۰۰۱ ۸۵: ۱۶-۲۲. ۱۴- Yordam N, Gönç EN, Kandemir N, Alikaşifoğlu A, Ozön A. Ten-year experience in management of diabetic ketoacidosis and ketosis: ۱۴۰ episodes at pediatric age. Turk J Pediatr. ۲۰۰۵ ۴۷: ۳۳۴-۸. ۱۵- Lin SF, Lin JD, Huang YY. Diabetic ketoacidosis: comparisons of patient characteristics, clinical presentations and outcomes today and ۲۰ years ago. Chang Gung Med J. ۲۰۰۵ ۲۸: ۲۴-۳۰. ۱۶- Flood RG, Chiang VW. Rate and prediction of infection in children with diabetic ketoacidosis. Am J Emerg Med. ۲۰۰۱ ۱۹: ۲۷۰-۳. ۱۷- Ganesh R, Arvindkumar R, Vasanthi T. Clinical profile and outcome of diabetic ketoacidosis in children. Natl Med J India. ۲۰۰۹ ۲۲: ۱۸-۹. ۱۸- Shiva S, Zarintan A. Clinical laboratory and epidemiological characteristics of diabetic ketoacidotic patients in children in Tabriz. J Tabriz Unive Med Sci. ۲۰۱۰ ۳۲: ۵۳-۵۷. ۱۹- Irigoyen M, Cuartero B, Castellanos R, et al. Ketoacidosis at onset of type ۱ diabetes mellitus in pediatric age in Spain and review of the literature. Pediatr Endocrinol Rev. ۲۰۱۲ ۹: ۶۶۹-۷۱. ۲۰- Onyiriuka AN, Ifebi E . Ketoacidosis at diagnosis of type ۱ diabetes in children and adolescents: frequency and clinical characteristics. J Diabetes Metab Disord. ۲۰۱۳ ۱۲: ۴۷ doi: ۱۰. ۱۱۸۶/۲۲۵۱-۶۵۸۱-۱۲-۴۷. ۲۱- Abdul-Rasoul M, Al-Mahdi M, Al-Qattan H, et al. Ketoacidosis at presentation of type ۱ diabetes in children in Kuwait: frequency and clinical characteristic. Pediatric Diabetes. ۲۰۱۰ ۱۱: ۳۵۱-۵۶.

Keywords:

Keywords: Complications , Diabetes , DKA , Ketoacidosis , Prognosis