Correlations Between Laboratory and Clinical Signs of Diabetic Ketoacidosis in Children

Introduction Diabetic ketoacidosis (DKA) is a critical and potentially life-threatening condition with a mortality rate of 9 % [1] that often occurs at the initial diagnosis of type I diabetes (T1D) in children. The presentation of DKA can vary widely among children and adolescents, often manifesting through a combination of classical symptoms such as polyuria, polydipsia, weight loss, and vomiting. These clinical signs, if correlated with specific blood gas findings like pH, bicarbonate (HCO3) levels, and base excess (BE), are essential for early diagnosis and effective management as well as prediction of the duration of hospitalization for pediatric patients with DKA [2]. Aim The aim of this study was to assess the relationships of the laboratory, clinical signs of DKA and duration of the treatment at pediatric intensive care unit (PICU) in children with T1D manifestation. Methods This is a retrospective study that was approved by Bioethics center of Lithuanian University of Health Sciences (LUHS) (2024-BEC2-1387). We analyzed data of 45 patients, treated at the Hospital of LUHS Kauno Klinikos, from July 25, 2023, to December 4, 2024. The study included all children and adolescents (0-18 years) who presented with DKA at the manifestation of T1D and came to Emergency Department at Kauno Klinikos. Clinical data as DKA symptoms, values of blood gasses, duration (in hours) of treatment at PICU were analyzed. Descriptive statistical analysis, Mann-Whitney U test, Spearman’s correlation were used for data analysis. Data is presented as median (min; max values), unless stated otherwise. P value <0.05 was considered as statistically significant, all tests were two-tailed. Statistical analysis was performed using IBM SPSS Statistics 30.0. Results This study included 45 participants, 18 (40.0 %) were female and 27 (60.0 %) male. The median age of the patients was 11 (1; 17) years. Polyuria presented in 37 (82.2 %) patients, polydipsia in 41 (91.1 %), weight loss in 30 (66.7 %), and vomiting in 12 (26.7 %). Blood gas analysis was performed for all 45 patients. The median pH value was statistically lower in patient who presented with vomiting vs. no vomiting, 7.17 (6.84; 7.41) vs 7.24 (6.89; 7.43), respectively (z=-3.126, p=0,001). No significant difference was observed when comparing pH levels in other symptom groups: polyuria vs no polyuria; polydipsia vs no polydipsia; and weight loss vs no weight loss. A negative correlation was found between the duration of treatment at PICU and initial arterial blood pH value (r=-0.470, p=0.001). Also, negative correlation was found between levels of HCO3 and duration of treatment at PICU (r=- 0.368, p=0.042). Conclusions Our study indicates that, while classical symptoms of DKA were common in children and adolescents with T1D manifestation, vomiting was significantly associated with laboratory findings, such as pH level. Lower bicarbonate levels and lower pH levels correlate with longer hospitalization at PICU.