engleski

Characteristics of patients with Diabetic ketoacidosis treated in two Pediatric Intensive Care Units in Croatia between 2013 and 2017

Introduction: There is an increasing incidence of type 1 diabetes mellitus (T1D) among children in Croatia. A study published in 2014 showed annual increase of 5.87% and that is higher than the European average, which is 3.9%. Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with T1D, with cerebral edema as most severe complication. Development of brain edema is likely a consequence of abnormalities in cerebral perfusion and inflammation that occur during DKA. Since early recognition of cerebral edema leads to better outcome, it is important that patients with moderate or severe DKA are closely monitored and treated in Pediatric Intensive Care Units (PICU). Objective: The aim of this study is to investigate clinical and laboratory parameters of children treated in PICU because of DKA. Materials and methods: Patients treated due to DKA in PICU of the University Hospitals of Split and Osijek from 2013 to 2017 were included in this study. Retrospectively collected data included age, gender, clinical signs and symptoms, and various laboratory parameters. After dividing subjects into two groups: newly diagnosed with T1D (NT1D) and previously diagnosed with T1D (PT1D), collected data was compared between the two groups. Results: Total of 82 patients were enrolled. Those with NT1D were more often treated in PICU. Decreased consciousness level was found in 41.5% of patients, with majority of them being somnolent. No difference was found between the groups. Of the total number of DKA patients, the rate of cerebral edema was 2.4% and both patients with cerebral edema belonged to the NT1D group. Dehydration was the most frequent clinical sign, found in 95% patients at admission. There was no significant difference regarding laboratory data at admission. Conclusions: More children with NT1D required treatment in PICU due to DKA with two of them developing cerebral edema. Since cerebral edema is a life threatening condition, treatment of patients with moderate or severe DKA in PICU will provide necessary monitoring enabling early recognition and treatment of cerebral edema and better treatment outcome. As the dehydration is the leading sign at admission, a good estimation of dehydration severity is important during the initial management as well. To minimize the incidence of DKA among NT1D it is important to continuously carry out public health education programs aimed to early identification of signs and symptoms of T1D. For patients with PT1D it is essential to well educate and support both children and their families aiming for good control of diabetes and prevention of complications.

children ; diabetic ketoacidosis, cerebral edema

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