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Factors associated with mortality in children with diabetic ketoacidosis (DKA) in South India

Research paper by V. Poovazhagi

Indexed on: 13 Aug '16Published on: 01 Sep '16Published in: International Journal of Diabetes in Developing Countries



Abstract

Abstract Mortality in diabetic ketoacidosis (DKA) among children has been reported to be 0.3–3 % in developed countries. Based on the limited data from developing countries, the mortality reported is as high as 13.4 %. A prospective study was conducted to identify the factors leading to high mortality in children with DKA in South India. This was a study of 118 episodes of DKA among children, admitted in a pediatric tertiary care center at Chennai. Clinical presentation, laboratory parameters at admission, parameters during treatment, and complications were considered as risk factors. All children were followed up till discharge from hospital or death. Univariate and multivariate analyses for risk factors were undertaken. Altered sensorium and higher osmolality at admission, delayed diagnosis, cerebral edema, shock, renal failure, and sepsis were the major risk factors associated with mortality in multivariate analysis. Cerebral edema was encountered in 23.7 %, shock in 12.7 %, sepsis in 11 %, and renal failure in 9.3 %. The overall mortality rate was 11 %. Delayed diagnosis may be the root cause for high mortality in children with DKA in developing countries. There is an urgent need to create awareness among physicians, teachers, and parents to avoid a delay in diagnosis and decrease the mortality in children with DKA. Higher incidence of cerebral edema, shock, renal failure, and sepsis are unique problems identified in this study. There is a need for further studies on fluid management of shock, strategies for management of renal failure in DKA, and use of antibiotics in DKA in developing countries.AbstractMortality in diabetic ketoacidosis (DKA) among children has been reported to be 0.3–3 % in developed countries. Based on the limited data from developing countries, the mortality reported is as high as 13.4 %. A prospective study was conducted to identify the factors leading to high mortality in children with DKA in South India. This was a study of 118 episodes of DKA among children, admitted in a pediatric tertiary care center at Chennai. Clinical presentation, laboratory parameters at admission, parameters during treatment, and complications were considered as risk factors. All children were followed up till discharge from hospital or death. Univariate and multivariate analyses for risk factors were undertaken. Altered sensorium and higher osmolality at admission, delayed diagnosis, cerebral edema, shock, renal failure, and sepsis were the major risk factors associated with mortality in multivariate analysis. Cerebral edema was encountered in 23.7 %, shock in 12.7 %, sepsis in 11 %, and renal failure in 9.3 %. The overall mortality rate was 11 %. Delayed diagnosis may be the root cause for high mortality in children with DKA in developing countries. There is an urgent need to create awareness among physicians, teachers, and parents to avoid a delay in diagnosis and decrease the mortality in children with DKA. Higher incidence of cerebral edema, shock, renal failure, and sepsis are unique problems identified in this study. There is a need for further studies on fluid management of shock, strategies for management of renal failure in DKA, and use of antibiotics in DKA in developing countries.