Study of Children with Diabetic Ketoacidosis Admitted to Pediatric Intensive Care Unit in Mansoura University Children Hospital: A Five Year Descriptive Retrospective Study

Diabetic Ketoacidosis (DKA) is a major cause of morbidity and mortality in children with T1DM. This study aimed to determine the risk factors, presenting features and initial treatment strategies in children admitted to pediatric intensive care unit (PICU) at Mansoura university children hospital (MUCH) with DKA during the period from 2019 to 2023. This retrospective descriptive study included data collected about demographic characteristics, clinical manifestations, laboratory data, treatment, complications and outcomes of children admitted. The study conducted on 93 children presented with DKA and were divided into two groups based on time of diagnosis of DM into children having previous diagnosis of DM (previously diagnosed) (n=32) and other newly diagnosed (n=61). HbA1c, basal K+, 8-hour level & 12-hour level, and fluid maintenance amount were significantly elevated in previously diagnosed patients compared to recently diagnosed cases. Both duration of IV fluids and duration of resolution of acidosis were significantly elevated in newly diagnosed patients compared to previously diagnosed patients. Complications were more frequent in newly diagnosed children compared to previously diagnosed children. Six children died, 5 from newly diagnosed group. Older age, infection, higher creatinine, elevated initial dose of insulin, longer duration of resolution of acidosis, need of HCO3 and presence of complication were independent predictors of poor outcome, while lower pH and lower GCS were significant predictive of poor outcome in univariate analysis. This study highlighted importance of early presentation and/or referral, and appropriate treatment of children with DKA according to MUCH PICU standard treatment guidelines.