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Evaluation of Clinical Differences of Newly Diagnosed and Formerly Diagnosed Pediatric Diabetic Ketoacidosis Patients

Year 2022, Volume: 16 Issue: 5, 409 - 414, 20.09.2022
https://doi.org/10.12956/tchd.1062697

Abstract

Objective: Our aim is to determine the severity, clinical features, presence of complications and outcome differences
in previously diagnosed and newly diagnosed Type 1 Diabetes Mellitus (T1DM) patients followed up with diabetic
ketoacidosis (DKA) in the pediatric intensive care unit.

Material and Methods: This study was conducted retrospectively in a 32-bed tertiary pediatric intensive care unit.
The patients were divided into newly diagnosed and previously diagnosed T1DM. All collected data were compared
between groups.

Results: 107 patients were included into the study. Most of the patients were male (51.4%). Most of the newly diagnosed
patients were in the 6-10 age group (49.2%). When patient complaints were evaluated before admission, the complaint
of nausea was statistically higher in previously diagnosed DM patients (p=0.041). The complaints of fatigue, polyuria,
polydipsia, and weight loss were statistically higher in newly diagnosed Type-1 DM (p value 0.001, 0.001, 0.001,
0.001, respectively). Hypokalemia was statistically higher in the newly diagnosed DM group during diabetic ketoacidosis
treatment (p=0.015). Although there was no difference between intensive care durations, total hospitalization days were
statistically longer in newly diagnosed DM patients (p values 0.145, 0.007, respectively). All patients survived.

Conclusion: The school age group was the most common age group in newly diagnosed T1DM. While polyuria,
polydipsia and weight loss are common in newly diagnosed Diabetic Ketoacidosis patients; Vomiting was common in
diabetic ketoacidosis patients with previous diagnosis. Trainings, national advertisements, etc. should be done to increase
the knowledge level of patients and families about these symptoms and the disease.

References

  • Referans1.) Lopes CLS, Pinherio PP, Barbarena LS, Eckert GU. Diabetic ketoacidosis in a pediatric intensive care unit. J Pediatr (Rio J).2017; 93(2):179-184.
  • Referans2.) Ampt A, Gemert TV, Craig ME, Donaghue KC, Lain SB, Nassar N. Pediatric Diabetes.2019;20(7):901-908.
  • Referans3.) Jawaid A, Sohaila A, Mohammed N, Rabbani U. Frequency, clinical characteristics, biochemical findings and outcomes of DKA at the onset of type-1 DM in young children and adolescents living in a developing country-an experience from pediatric emergency department. J Pediatr Endocrinol Metab. 2019;32(2):115-119.
  • Referans4.)Pozo PD, Aranguiz D, Cordova G, Scheu C, Valle P, Cerda J, Garcia H, Hodgson MI, Castillo A. Rev Chil pediatr.2018;89(4):491-498.
  • Referans5.)Wolfsdorf JI, Glaser N, Agus M et al. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatric Diabetes. 2018; 19 (Suppl. 27): 155–177.
  • Referans6.)Lee HJ, Yu HW, Jung HW et all.Factors Associated with the Presence and Severity of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Korean Children and Adolescents.J Korean Med Sci 2017; 32: 303-309.
  • Referans7.) Esen I, Okdemir D. The Frequency of Ketoacidosis and Associated Factors at the diagnosis of Type 1 Diabetes in Turkish Children: A Single-Center Experience and Literature Review. J Pediatr Res.2021;8(3):309-19.
  • Referans8.) Choleau C, Maitre J, Pierucci AF et al. Ketoacidosis at diagnosis of type 1 diabetes in French children and adolescents. Diabetes&Metabolism:2014;40:135-142.
  • Referans9.) Aras B, Akın A, Yıldırım R ve ark. Tip 1 Diyabetes Mellituslu Cocuklarda tanı anındaki Klinik ve Laboratuar Bulgularının Değerlendirilmesi. Dicle Med J(2019);46:11-17.
  • Referans10.) Ongun EA, Celik N. Risk Factors associated with resolution of diabetic ketoacidosis in pediatric critical care units. Cumh. Med.Journal.2019;41:42-50.
  • Referans11.) Koyuncu E, Saglam H, Tarim O. Diyabetik Ketoasidozla Başvuran Çocuk Olguların Değerlendirilmesi. J Curr Pediatr.2016;14:116-23.
  • Referans12.) Bayoglu DS, Akıcı N, Bayoglu V ve ark. Tip 1 Diyabetli Çocukların Klinik ve Epidemiyolojik Özellikleri. Haydarpasa Numune Egitim ve Arastirma Hastanesi Tıp Dergisi.2014;54:87-92.
  • Referans13.) Levy-Marchal C, Patterson CC, Green A, Europe EASG, Diabetes. Geographical variation of presentation at diagnosis of type I diabetes in children:the EURODIAB study.European and Diabetes. Diabetologia 2001;44(Suppl 3):B75-80.doi:10.1007/pl00002958.
  • Referans14.) Acar S, Goren Y, Paketci A ve ark. Tip 1 Diabetes Mellitus Olgularının Tanı Anindaki Diyabetik Ketoasidoz Sıklığının değişimi:On Beş Yıllık Tek Merkez Deneyimi. J Pediatr Res;2017.4.143-8.
  • Referans15.) Szypowska A, Ramotowska A, Grzechnik-Gryziak M et al. High frequency of Diabetic Ketoacidosis in Children with Newly Diagnosed Type 1 Diabetes. Journal of Diabetes Research.2016:9582793. doi: 10.1155/2016/9582793.
  • Referans16.) Demir K, Buyukinan M, Dizdarer C ve ark. Tip 1 Diyabetli çocuklarda tanıda Diyabetik Ketoasidoz Sıklığı ve ilişkili faktörler. Guncel Pediatri Dergisi.2010;8:52-55.

Eski ve Yeni Tanı Pediatrik Diyabetik Ketoasidoz Hastalarının Klinik Farklılıkların Değerlendirilmesi

Year 2022, Volume: 16 Issue: 5, 409 - 414, 20.09.2022
https://doi.org/10.12956/tchd.1062697

Abstract

Amaç: Amacımız, çocuk yoğun bakım ünitesinde diyabetik ketoasidoz (DKA) ile takip edilen daha önce tanı almış ve yeni tanı almış Tip 1
Diabetes Mellitus (T1DM) hastalarının şiddeti, klinik özellikleri, komplikasyon varlığı ve sonuç farklılıklarını belirlemektir.

Gereç ve Yöntemler: Bu çalışma, 32 yataklı üçüncü basamak çocuk yoğun bakım ünitesinde geriye dönük olarak yapıldı. Hastalar yeni
tanı almış ve önceden tanı almış T1DM olarak ayrıldı. Toplanan tüm veriler gruplar arasında karşılaştırıldı.

Bulgular: 107 hasta çalışmaya dahil edildi. Hastaların çoğu erkekti (%51.4). Yeni tanı alan hastaların çoğu 6-10 yaş grubundaydı (%49.2).
Başvuru öncesi hasta şikâyetleri değerlendirildiğinde kusma şikayeti, daha önce tanı almış DM hastalarında istatistiksel olarak anlamlı
derecede yüksekti (p=0.041). Yeni tanı alan Tip-1 DM’de halsizlik, poliüri, polidipsi, kilo kaybı şikâyetleri istatistiksel olarak anlamlı derecede
yüksekti (p değeri sırasıyla 0.001, 0.001, 0.001, 0.001). Diyabetik ketoasidoz tedavisi sırasında yeni tanı almış DM grubunda hipokalemi
istatistiksel olarak daha yüksekti (p=0.015). Yoğun bakım süreleri arasında fark olmamasına rağmen yeni tanı konmuş DM hastalarında
toplam yatış günleri istatistiksel olarak daha uzundu (p değerleri sırasıyla 0.145, 0.007). Hastalarda mortalite görülmedi.

Sonuç: Okul yaş grubu, yeni tanı konan T1DM’de en sık görülen yaş grubuydu. Yeni tanı Diyabetik Ketoasidoz hastalarında poliüri,
polidipsi, kilo kaybı sık iken; eski tanılı diyabetik ketoasidoz hastalarında kusma yaygın olarak saptandı. Hastalar ve ailelerin bu semptomlar
ve hastalık hakkında bilgi düzeyini artırıcı eğitimler, ulusal reklamlar vb uygulamalar yapılmalıdır.

References

  • Referans1.) Lopes CLS, Pinherio PP, Barbarena LS, Eckert GU. Diabetic ketoacidosis in a pediatric intensive care unit. J Pediatr (Rio J).2017; 93(2):179-184.
  • Referans2.) Ampt A, Gemert TV, Craig ME, Donaghue KC, Lain SB, Nassar N. Pediatric Diabetes.2019;20(7):901-908.
  • Referans3.) Jawaid A, Sohaila A, Mohammed N, Rabbani U. Frequency, clinical characteristics, biochemical findings and outcomes of DKA at the onset of type-1 DM in young children and adolescents living in a developing country-an experience from pediatric emergency department. J Pediatr Endocrinol Metab. 2019;32(2):115-119.
  • Referans4.)Pozo PD, Aranguiz D, Cordova G, Scheu C, Valle P, Cerda J, Garcia H, Hodgson MI, Castillo A. Rev Chil pediatr.2018;89(4):491-498.
  • Referans5.)Wolfsdorf JI, Glaser N, Agus M et al. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatric Diabetes. 2018; 19 (Suppl. 27): 155–177.
  • Referans6.)Lee HJ, Yu HW, Jung HW et all.Factors Associated with the Presence and Severity of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Korean Children and Adolescents.J Korean Med Sci 2017; 32: 303-309.
  • Referans7.) Esen I, Okdemir D. The Frequency of Ketoacidosis and Associated Factors at the diagnosis of Type 1 Diabetes in Turkish Children: A Single-Center Experience and Literature Review. J Pediatr Res.2021;8(3):309-19.
  • Referans8.) Choleau C, Maitre J, Pierucci AF et al. Ketoacidosis at diagnosis of type 1 diabetes in French children and adolescents. Diabetes&Metabolism:2014;40:135-142.
  • Referans9.) Aras B, Akın A, Yıldırım R ve ark. Tip 1 Diyabetes Mellituslu Cocuklarda tanı anındaki Klinik ve Laboratuar Bulgularının Değerlendirilmesi. Dicle Med J(2019);46:11-17.
  • Referans10.) Ongun EA, Celik N. Risk Factors associated with resolution of diabetic ketoacidosis in pediatric critical care units. Cumh. Med.Journal.2019;41:42-50.
  • Referans11.) Koyuncu E, Saglam H, Tarim O. Diyabetik Ketoasidozla Başvuran Çocuk Olguların Değerlendirilmesi. J Curr Pediatr.2016;14:116-23.
  • Referans12.) Bayoglu DS, Akıcı N, Bayoglu V ve ark. Tip 1 Diyabetli Çocukların Klinik ve Epidemiyolojik Özellikleri. Haydarpasa Numune Egitim ve Arastirma Hastanesi Tıp Dergisi.2014;54:87-92.
  • Referans13.) Levy-Marchal C, Patterson CC, Green A, Europe EASG, Diabetes. Geographical variation of presentation at diagnosis of type I diabetes in children:the EURODIAB study.European and Diabetes. Diabetologia 2001;44(Suppl 3):B75-80.doi:10.1007/pl00002958.
  • Referans14.) Acar S, Goren Y, Paketci A ve ark. Tip 1 Diabetes Mellitus Olgularının Tanı Anindaki Diyabetik Ketoasidoz Sıklığının değişimi:On Beş Yıllık Tek Merkez Deneyimi. J Pediatr Res;2017.4.143-8.
  • Referans15.) Szypowska A, Ramotowska A, Grzechnik-Gryziak M et al. High frequency of Diabetic Ketoacidosis in Children with Newly Diagnosed Type 1 Diabetes. Journal of Diabetes Research.2016:9582793. doi: 10.1155/2016/9582793.
  • Referans16.) Demir K, Buyukinan M, Dizdarer C ve ark. Tip 1 Diyabetli çocuklarda tanıda Diyabetik Ketoasidoz Sıklığı ve ilişkili faktörler. Guncel Pediatri Dergisi.2010;8:52-55.
There are 16 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases
Journal Section ORIGINAL ARTICLES
Authors

Serhan Özcan 0000-0003-4465-6063

Seçil Akay This is me 0000-0002-6001-0716

İrem Bozkurt 0000-0003-4773-3642

Emel Uyar 0000-0002-8265-0618

Oktay Perk 0000-0002-2586-5954

Abdurrahman Bitkay 0000-0001-7037-6001

Aylin Kılınç Uğurlu 0000-0003-1265-4952

Serhat Emeksiz 0000-0002-8951-4774

Publication Date September 20, 2022
Submission Date January 26, 2022
Published in Issue Year 2022 Volume: 16 Issue: 5

Cite

Vancouver Özcan S, Akay S, Bozkurt İ, Uyar E, Perk O, Bitkay A, Kılınç Uğurlu A, Emeksiz S. Evaluation of Clinical Differences of Newly Diagnosed and Formerly Diagnosed Pediatric Diabetic Ketoacidosis Patients. Turkish J Pediatr Dis. 2022;16(5):409-14.


The publication language of Turkish Journal of Pediatric Disease is English.


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