Correlation between Serum Albumin Level and Diabetic Ketoacidosis among Children with Type I Diabetes

Background: Diabetic ketoacidosis (DKA) is a state of catabolism, where protein breakdown prompts decline in serum albumin levels. As a result, hypoalbuminemia could serve as a valuable indicator of the risk of ketosis, which in turn implies an underlying deficiency in insulin. Objectives: Evaluation of serum albumin level and its correlation with DKA severity among Type 1 diabetes mellitus children (T1DM). Patients and methods: This cross-sectional study included 100 children with DKA admitted to pediatric intensive care unit (PICU), Al-Azhar University Hospital, New Damietta from July 2023 to May 2024. Patients were divided into three groups according to severity of DKA. Demographic, anthropometric data, medical history, arterial blood gases (ABG), random blood glucose (RBG), complete blood count (CBC), glycated hemoglobin (HbA1c), albumin, prothrombin time (PT), international normalized ratio (INR), serum electrolytes (Na and K) and urine analysis data were collected. Results: The median age of cases was 10 (7-10.5) years and there was a predominance of male gender (60%). The majority of cases (58%) had severe DKA, (22%) had moderate DKA and (20%) had mild DKA. Albumin showed statistically lower levels among severe DKA patients 3.34 ± 0.52 gm/dl compared to mild DKA patients 3.65 ± 0.57 gm/dl with a sensitivity of 67.2% and a specificity of 85.7% to detect severe DKA cases at a cutoff of 3.05 gm/dl. There was also a significant negative correlation between albumin levels and frequency of DKA in the past 6 months (r=-0.435, p-value=0.001). Conclusion: Albumin levels were significantly associated with severity of DKA demonstrating significant difference between mild and severe cases of DKA. Additionally, cases with lower levels of albumin had significantly higher frequency of DKA during the last 6 months prior to our study.