Frequency, precipitating factors and outcome of diabetic ketoacidosis in type 1 diabetes at tertiary care hospital

Introduction: Cardiac arrhythmias and arrest have been described in children with diabetic ketoacidosis and generally have been presumed to be caused by electrolyte abnormalities. The rationale of this study was to assess the role and importance of ECG monitoring, as a simple, quick, non-invasive and readily available tool in the diagnosis and confirmation of hypokalemia and hyperkalemia in patients with DKA in the Emergency Department Objective: To Assess the Frequency of electrocardiographic changes in Type-1 diabetes mellitus children with diabetic ketoacidosis presenting to tertiary care hospital, Karachi. Materials and Methods: This retrospective cross sectional study was carried out at the department of pediatric medicine, NICH Karachi. At the time of presentation, the standard 12-lead ECG was recorded by a single pediatric cardiologist having more than 2 years of experience, QT and RR intervals were measured. Three separate measurements were obtained from each ECG, and the mean of these measurements was used as the value for QTC. QTC of at least 0.45s (450ms) was considered as prolonged QTC. QTD was also assessed at the same time and QTD>50 ms was considered as prolonged QTD. Results: One hundred cases of T1DM with DKA were included in this study. Average age of children was 7.9 ±3.5 years (Min – Max = 0.5 – 14 years), male to female ratio was 1: 0.96. Prolong QTc and QTd interval was observed in (56%) and (38%) children respectively, Mean (±SD) QTc and QTd interval was 449.4 ±36.6 mc and 39.3 ±16.1 mc respectively. While ECG changes were found in (58%) cases. Association between ECG changes and the cases with higher RBS (>350 mg/dl) was statistically significant 81 (81%) cases with ECG changes had higher RBS (p<0.0001) while ECG changes were statistically similar in both age groups and gender (p-values > 0.05). Conclusion: The frequency of ECG changes was higher in T1DM children with diabetic ketoacidosis. ECG changes was significantly associated with higher RBS (>350 mg/dl). Key words: T1DM, Diabetic Ketoacidosis, ECG, QTc, QTd

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Implementation and Evaluation of a Diabetic Ketoacidosis Order Set in Pediatric Type 1 Diabetes at a Tertiary Care Hospital: A Quality-Improvement Initiative

Canadian Journal of Diabetes ◽

10.1016/j.jcjd.2018.12.005 ◽

2019 ◽

Vol 43 (5) ◽

pp. 297-303 ◽

Cited By ~ 2

Author(s):

Kayla Flood ◽

Munier Nour ◽

Tanya Holt ◽

Vicki Cattell ◽

Carla Krochak ◽

...

Keyword(s):

Type 1 Diabetes ◽

Quality Improvement ◽

Diabetic Ketoacidosis ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Quality Improvement Initiative ◽

Care Hospital ◽

Pediatric Type 1 Diabetes ◽

Order Set

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Comparison of outcome of milwaukee regimen and 48 hours regimen in diabetic ketoacidosis in a tertiary care hospital in Chitradurga, Karnataka, India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20201651 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1123

Author(s):

Basavanthappa S. P. ◽

Srinivasa V. ◽

Sivachand T.

Keyword(s):

Diabetic Ketoacidosis ◽

Tertiary Care Hospital ◽

Average Length ◽

Venous Blood ◽

Tertiary Care ◽

Medical Emergency ◽

Care Hospital ◽

Mortality And Morbidity ◽

Pediatric Age Group

Background: Diabetic ketoacidosis (DKA) is an acute life threatening and a medical emergency that accounts for the majority of diabetes related mortality and morbidity in the pediatric age group who are suffering from type 1 Diabetes Mellitus (DM). Objective of this study was to compare the clinical outcome in a patient with DKA who are been treated with Milwaukee regimen (24hours) and 48 hours regimen.Methods: A retrospective study was conducted in PICU of tertiary care hospital in Chitradurga, Karnataka. Data was collected from 2015 to May 2018. Diagnosis of DKA was made by plasma glucose level higher than 200mg/dl, venous blood PH of <7.3 and /or bicarbonate <15 mmol/L, presence of ketonuria. Among 56 cases, 36 cases were treated with 48 hours regimen and 20 cases were treated with Milwaukee regimen and results were compared.Results: The median age of presentation was 7.52 years (Range: 2-14 years) with female: male ratio of 1:1.3. Newly diagnosed type 1 DM cases constituted 80.7%. The most common presenting complaints were hurried breathing and altered sensorium. The average length of stay in the ICU was 3.5 days for 48 hours regimen and 4.5 days for Milwaukee regimen. The mortality rate was 10.71 % (6 cases), among which 15% (3 cases) were patients treated with Milwaukee and 8.3% (3 cases) were patients treated with 48 hours regimen. Cerebral edema was found to be the commonest cause of fatality.Conclusions: There is lack of awareness regarding dog bite and its management among the rural population.

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Clinical and biochemical profile of 786 sequential episodes of diabetic ketoacidosis in adults with type 1 and type 2 diabetes mellitus

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2021-002451 ◽

2021 ◽

Vol 9 (2) ◽

pp. e002451

Author(s):

Emma Ooi ◽

Katrina Nash ◽

Lakshmi Rengarajan ◽

Eka Melson ◽

Lucretia Thomas ◽

...

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Diabetic Ketoacidosis ◽

Tertiary Care ◽

Final Analysis ◽

Care Hospital ◽

Hospital Data ◽

Management Protocol

IntroductionWe explored the clinical and biochemical differences in demographics, presentation and management of diabetic ketoacidosis (DKA) in adults with type 1 and type 2 diabetes.Research design and methodsThis observational study included all episodes of DKA from April 2014 to September 2020 in a UK tertiary care hospital. Data were collected on diabetes type, demographics, biochemical and clinical features at presentation, and DKA management.ResultsFrom 786 consecutive DKA, 583 (75.9%) type 1 diabetes and 185 (24.1%) type 2 diabetes episodes were included in the final analysis. Those with type 2 diabetes were older and had more ethnic minority representation than those with type 1 diabetes. Intercurrent illness (39.8%) and suboptimal compliance (26.8%) were the two most common precipitating causes of DKA in both cohorts. Severity of DKA as assessed by pH, glucose and lactate at presentation was similar in both groups. Total insulin requirements and total DKA duration were the same (type 1 diabetes 13.9 units (9.1–21.9); type 2 diabetes 13.9 units (7.7–21.1); p=0.4638). However, people with type 2 diabetes had significantly longer hospital stay (type 1 diabetes: 3.0 days (1.7–6.1); type 2 diabetes: 11.0 days (5.0–23.1); p<0.0001).ConclusionsIn this population, a quarter of DKA episodes occurred in people with type 2 diabetes. DKA in type 2 diabetes presents at an older age and with greater representation from ethnic minorities. However, severity of presentation and DKA duration are similar in both type 1 and type 2 diabetes, suggesting that the same clinical management protocol is equally effective. People with type 2 diabetes have longer hospital admission.

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Clinical profile of type 1 diabetes mellitus in a tertiary care hospital

International Journal of Diabetes in Developing Countries ◽

10.1007/s13410-015-0366-4 ◽

2015 ◽

Vol 36 (2) ◽

pp. 146-149 ◽

Cited By ~ 1

Author(s):

Ayyagari Mythili ◽

K. Dileep Kumar ◽

B. Vivekananda ◽

K. A. V. Subrahmanyam

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Clinical Profile ◽

Care Hospital

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A Prospective Analysis of Lipid Profile in Children with Type 1 Diabetes in a Tertiary Care Hospital

International Archives of BioMedical and Clinical Research ◽

10.21276/iabcr.2016.2.3.17 ◽

2016 ◽

Vol 2 (3) ◽

Author(s):

Shweta Singh ◽

Chandra Mohan Kumar

Keyword(s):

Type 1 Diabetes ◽

Lipid Profile ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Prospective Analysis ◽

Care Hospital

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Precipitating factors, clinical features and outcome of diabetic ketoacidosis in children and adolescents admitted in a tertiary care hospital in Dhaka

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v13i1.17429 ◽

2013 ◽

Vol 13 (1) ◽

pp. 53-57

Author(s):

Rubaiya Islam ◽

Shahida Akhter ◽

Rumana Shelim ◽

Fauzia Mohsin ◽

Tahmina Begum ◽

...

Keyword(s):

Children And Adolescents ◽

Diabetic Ketoacidosis ◽

Clinical Features ◽

Tertiary Care ◽

Medical Science ◽

Background Information ◽

Care Hospital ◽

Precipitating Factors ◽

Precipitating Factor

Background Information: Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus (DM). It is an acute complication of type 1 DM. Objective: This study was designed to identify the precipitating factors, clinical features and immediate outcomes of DKA in children and adolescents. Method: This was a retrospective study which was done in the department of Pediatrics, BIRDEM, from January 2002 to April 2007. Data were collected from the hospital record for all diabetic children below 18 years admitted with DKA. Result: Fourty nine children and adolescents were admitted with DKA. Sixty one percent were known cases and the remaining (39%) were new DM. Majority were female (63%). Most (49%) of the children were between 11- 15 years. Infection was the commonest (49%) precipitating factor followed by insulin omission (24%). Major clinical features were kussmaul breathing (94%) and dehydration (94%).Eighty eight percent patients improved after treatment and mortality was 12%. Conclusion: Infection was the commonest precipitating factor of DKA. Kussmaul breathing and dehydration were the commonest clinical features. Most of the patients improved after treatment.DOI: http://dx.doi.org/10.3329/bjms.v13i1.17429 Bangladesh Journal of Medical Science Vol. 13 No. 01 January2014: 53-57

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