[Frequency and clinical manifestation of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes].

INTRODUCTION

Diabetic ketoacidosis (DKA) is still the most dangerous acute complication of type 1 diabetes mellitus (T1DM). It is a life-threatening condition requiring intensive treatment. DKA may be the first symptom of previously undiagnosed diabetes, especially in children.

AIM OF THE STUDY

Assessment of the incidence and clinical manifestation of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes.

MATERIAL AND METHODS

We analyzed 535 medical files of children (aged 9 months to 17 years, mean age 4.41-9.96, 261 girls (48%)) hospitalized from 2006 to 2009 because of the newly diagnosed type 1 diabetes mellitus. DKA was diagnosed (according to ISPAD) in children with pH <7.3, blood glucose level >11 mmol/L (>200 mg/dL) and/or blood concentration of bicarbonate <15 mmol/L with ketonuria. Severe DKA was diagnosed in children with pH <7.2.

RESULTS

DKA was diagnosed in 123 patients (23%) (63 girls (51%)). The mean age of children with DKA was significantly lower than the age of the children without DKA (9.05-4.45 vs 9.48-4.39 years; p<0.001). Mean pH was 7.21-1.03 (min. 6,82; max. 7,30). In 32.5% of children with DKA severe ketoacidosis (pH -7.2) was observed. The prevalence of acidosis was higher in the 0-4 age group compared to children over 4 years (28 vs. 22%, p<0.001). Neither sex, nor symptoms duration were associated with the development of DKA. Polyuria (95%), polydipsia (95%), weight loss (85%) and abdominal pain (50%) were the most common symptoms reported by patients.

CONCLUSIONS

Despite the typical symptomatology of type 1 diabetes mellitus, about 1/4 of newly diagnosed diabetes in children is accompanied by ketoacidosis. The risk of acidosis is greater in younger children.