Diabetic ketoacidosis in pediatric patients with type1- and type2 diabetes during the COVID-19 pandemic

Metabolism ◽  
2021 ◽  
pp. 154842
Author(s):  
Charlotte Loh ◽  
Paul Weihe ◽  
Nicole Kuplin ◽  
Kerstin Placzek ◽  
Susann Weihrauch-Blüher
Keyword(s):  
Diabetic Ketoacidosis ◽  
Pediatric Patients ◽  
Type2 Diabetes

scholarly journals New onset diabetes with diabetic ketoacidosis in a child with multisystem inflammatory syndrome due to COVID-19

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Monica N. Naguib ◽  
Jennifer K. Raymond ◽  
Alaina P. Vidmar
Keyword(s):  
Metabolic Acidosis ◽  
Diabetic Ketoacidosis ◽  
Pediatric Patients ◽  
Systolic Function ◽  
Hemodynamic Instability ◽  
Case Presentation ◽  
Onset Diabetes ◽  
Potential Trigger ◽  
Inflammatory Syndrome ◽  
New Onset

AbstractIntroductionMultisystem inflammatory syndrome in children (MIS-C) is a unique clinical complication of SARS-CoV-2 infection observed in pediatric patients. COVID-19 is emerging as a potential trigger for the development of diabetes in children. Here, we report a patient presenting with MIS-C and new onset diabetes, and discuss the implication and clinical management of these concomitant conditions.Case presentationAn eight-year-old female presented with hyperglycemia, ketosis and metabolic acidosis consistent with diabetic ketoacidosis (DKA) in the setting of fever, rash, respiratory distress, hemodynamic instability, reduced systolic function with dilation of the left anterior descending artery, and positive SARS-CoV-2 antibodies suggestive of MIS-C.

Pediatric Diabetic Ketoacidosis and Hypoglycemia

2020 ◽  
Author(s):  
Rachel J Williams ◽  
Samantha L. Wood
Keyword(s):  
Emergency Department ◽  
Key Words ◽  
Diabetic Ketoacidosis ◽  
Critically Ill ◽  
Cerebral Edema ◽  
Critically Ill Patients ◽  
Pediatric Patients ◽  
Serum Glucose ◽  
Neurologic Function ◽  
Threat To Life

Abnormalities of serum glucose in pediatric patients are commonly encountered in the emergency department and represent an acute threat to life and neurologic function. Rapidly identifying and aggressively treating hyperglycemia with diabetic ketoacidosis and hypoglycemia are critical to ensure the best possible outcome. This review will guide the emergency provider in the identification, resuscitation, workup, and disposition of these critically ill patients. This review contains 6 figures, 13 tables, and 50 reviews. Key Words: Cerebral edema, diabetic ketoacidosis, hyperglycemia, hypoglycemia

FAMILY HISTORY OF DIABETES IS ASSOCIATED WITH INCREASED RISK OF RECURRENT DIABETIC KETOACIDOSIS IN PEDIATRIC PATIENTS

2020 ◽  
Vol 26 (3) ◽  
pp. 305-311
Author(s):  
Janaki D. Vakharia ◽  
Sungeeta Agrawal ◽  
Janine Molino ◽  
Lisa Swartz Topor
Keyword(s):  
Diabetes Mellitus ◽  
Family History ◽  
Diabetic Ketoacidosis ◽  
Pediatric Patients ◽  
Incidence Rate Ratio ◽  
Family History Of Diabetes ◽  
Increased Risk ◽  
History Of

Objective: To determine the relationship between family history of diabetes mellitus (DM) and diabetic ketoacidosis (DKA) recurrence in youth with established type 1 diabetes mellitus (T1DM). Methods: We performed a retrospective chart review of patients with DKA admitted to a pediatric hospital between January, 2009, and December, 2014. We compared patients with recurrent (≥2 admissions) and nonrecurrent DKA (1 admission) and investigated patient level factors, including family history, that may be associated with DKA recurrence in pediatric patients with established T1DM. Results: Of the 131 subjects in the study, 51 (39%) subjects were in the recurrence group. Age ≥15 years old, public health insurance, and family history of T1DM or type 2 diabetes mellitus were associated with recurrent DKA admissions in both univariable and multivariable analyses. Family history was associated with DKA recurrence, with an incidence rate ratio of 1.5 (95% confidence interval = 1.0 to 2.3; P = .03). The association was not explained by type of familial diabetes, first degree relative status, or whether the family member lived in the household. Conclusion: Recognition that a positive family history of DM may be associated with a higher risk for DKA recurrence in patients with established T1DM may allow for targeted education and focus on a previously unidentified population at increased risk for DKA. Understanding the mechanism underlying the effect of family history of diabetes on the rates of DKA in patients with established T1DM may allow for improved identification and education of patients who may be at risk for DKA recurrence. Abbreviations: CI = confidence interval; DKA = diabetic ketoacidosis; EHR = electronic health record; IBD = inflammatory bowel disease; IRR = incidence rate ratio; T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus

QTc Prolongation in Pediatric Patients with Diabetic Ketoacidosis

2021 ◽  
Vol 228 ◽  
pp. 235-239.e2 ◽  
Author(s):  
Michelle M. Perez ◽  
Shivanand Medar ◽  
Leanne Quigley ◽  
Bradley C. Clark
Keyword(s):  
Diabetic Ketoacidosis ◽  
Pediatric Patients ◽  
Qtc Prolongation

scholarly journals Impact of Body Habitus on the Outcomes of Pediatric Patients With Diabetic Ketoacidosis

2021 ◽  
Vol 26 (2) ◽  
pp. 194-199
Author(s):  
Brady S. Moffett ◽  
Joseph Allen ◽  
Mahmood Khichi ◽  
Bonnie McCann-Crosby
Keyword(s):  
Adverse Events ◽  
Continuous Infusion ◽  
Diabetic Ketoacidosis ◽  
Pediatric Patients ◽  
Subcutaneous Insulin ◽  
Insulin Initiation ◽  
Body Habitus ◽  
Normal Body ◽  
Beta Hydroxybutyrate ◽  
New Onset

OBJECTIVE To determine whether obese and overweight pediatric patients with new onset diabetic ketoacidosis (DKA) treated with continuous infusion insulin have increased time to subcutaneous insulin initiation or adverse events as compared with patients with normal body habitus. METHODS A retrospective, cohort study was designed that included patients 2 to 18 years of age admitted with new onset DKA who received continuous infusion insulin from January 1, 2011, to December 31, 2017. Patients were stratified according to BMI percentile with the primary outcome of time to initiation of subcutaneous insulin. Secondary endpoints included time to minimum beta-hydroxybutyrate, and incidence of hypoglycemia or other adverse events. RESULTS A total of 337 patients (46.6% male, 9.6 ± 3.8 years of age) met study criteria. Patients were classified by body habitus as obese (7.7%, n = 26), overweight (7.1%, n = 24), normal body weight (58.8%, n = 198), or underweight (26.4%, n = 89), based on BMI percentile. Most patients were initiated on insulin at 0.1 unit/kg/hr (86.7%) for 16.7 ± 7.0 hours. Time from continuous infusion insulin initiation to subcutaneous insulin was not different between body habitus groups, nor was hypoglycemia or the use of mannitol (p > 0.05). Median time to lowest beta-hydroxybutyrate was greater for obese (26.4, IQR [13.9, 41.9]) and overweight (32.4, IQR [18.3, 47.0]) groups than for normal body habitus patients (16.5, IQR [12.3, 23.8]) (p < 0.05). CONCLUSIONS Time to subcutaneous insulin and adverse events was not associated with body habitus, but obese and overweight patients may have delayed beta-hydroxybutyrate clearance.

scholarly journals Association of Area Deprivation and Diabetic Ketoacidosis Readmissions: Comparative Risk Analysis of Adults vs Children With Type 1 Diabetes

2019 ◽  
Vol 104 (8) ◽  
pp. 3473-3480 ◽  
Author(s):  
Estelle Everett ◽  
Nestoras Mathioudakis
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Pediatric Patients ◽  
Cross Sectional Study ◽  
Adult Patients ◽  
Area Deprivation ◽  
Multivariable Logistic Regression Analysis ◽  
Cross Sectional ◽  
Comparative Risk

Abstract Objective Recurrent diabetic ketoacidosis (DKA) is associated with mortality in adults and children with type 1 diabetes (T1D). We aimed to evaluate the association of area deprivation and other patient factors with recurrent DKA in pediatric patients compared with adults. Research Design and Methods This cross-sectional study used the Maryland Health Services Cost Review Commission’s database to identify patients with T1D admitted for DKA between 2012 and 2017. Area deprivation and other variables were obtained from the first DKA admission of the study period. Multivariable logistic regression analysis was performed to determine predictors of DKA readmissions. Interactions (Ints) evaluated differences among the groups. Results There were 732 pediatric and 3305 adult patients admitted with DKA. Area deprivation was associated with higher odds of readmission in pediatric patients than in adults. Compared with the least deprived, moderately deprived pediatric patients had an OR of 7.87-(95% CI, 1.02 to 60.80) compared with no change in odds in adults for four or more readmissions (Pint < 0.01). Similar odds were observed in the most deprived pediatric patients, which differed significantly from the OR of 2.23 (95% CI, 1.16 to 4.25) in adults (Pint of 0.2). Moreover, increasing age, female sex, Hispanic ethnicity, and discharge against medical advice conferred a high odds for four or more readmissions in pediatric patients compared with adults. Conclusion Area deprivation was predictive of recurrent DKA admissions, with a more pronounced influence in pediatric than adult patients with T1D. Further studies are needed to understand the mechanisms behind these associations and address disparities specific to each population.

Evaluation of Thiol/Disulfide Homeostasis in Pediatric Patients with Diabetic Ketoacidosis

2020 ◽  
Vol 23 (3) ◽  
pp. 185-190
Author(s):  
Mutlu U. Yazıcı ◽  
Ganime Ayar ◽  
Semra Çetinkaya ◽  
Meliksah Keskin ◽  
Ebru Azapağası ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Measurement Method ◽  
Pediatric Patients ◽  
Demographic Data ◽  
Pediatric Intensive Care ◽  
Control Group ◽  
Gender And Age ◽  
One Year

Aim and Objective: This study aimed to investigate the value of Thiol/Disulfide homeostasis in pediatric diabetic ketoacidosis patients suffering from type 1 diabetes mellitus. Materials and Methods: This study featured children who were diagnosed with diabetic ketoacidosis and who were consecutively admitted to pediatric intensive care within one year of their diagnosis. Thiol/disulfide homeostasis was evaluated in 45 pediatric patients suffering from DKA, as well as 45 healthy controls of parallel gender and age. Thiol/disulfide homeostasis parameters were measured using a novel automated measurement method and the correlation between demographic data and parameters was measured. Results: Pediatric patients were found to have low native thiols, total thiols and disulfide levels with type 1 diabetes after DKA (331.82±106.40, 362.71±113.31, 17.02±5.33 μmol/L, respectively) as compared to the control group (445.08±24.41, 481.21± 28.47, 18.06±5.12 μmol/L, respectively). Conclusion: Thiol/disulfide homeostasis was distorted in pediatric patients with DKA. Furthermore, it was found that they are not likely to return to normal, immediately after treatment.

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