Presentation of Children with Diabetic Ketoacidosis in a Tertiary Pediatric Emergency Department in Costa Rica

Background: Children with diabetic ketoacidosis (DKA) present frequently to the emergency department (ED). Most children recover when treated with insulin, intravenous fluids, and electrolyte replacement; however, infrequent complications, such as cerebral edema may occur. We describe the presentation in the ED of children with DKA in Costa Rica.

Methods: Retrospective case series of patients aged 1 month to 15 years presenting to a tertiary ED with DKA during a 5-year period. Univariate analysis was performed with Odds ratios (ORs) and 95% confidence intervals (CIs). Comparisons were made between the groups using logistic regression.

Results: 104 patients were identified. Mean age was 8.6 years (SD 3.8) and 64% were female. Median time from onset of symptoms to ED presentation was 15 days (IQR 3-22 days). Sixty of the patients were previously healthy. Precipitating factor was identified in 20(29%) and 24 (23%) were DM 1 with poor control. Most presented with progressive onset of symptoms (73%). Vomiting (54%), polydipsia (75%) and polyuria (72%) were the most frequent symptoms. On examination dry oral mucosa (80%), lethargy (27%) and abdominal pain (20%) were the most common signs. The degree of dehydration on arrival was mild in 19 (18%), moderate in 41 (39%) and severe in 29 (28%). Laboratory findings on arrival: mean pH 7.14 (SD 0.14); bicarbonate 8.2 (SD 3.68); PCO2 23.6 (SD 7.4); sodium 133.63 (SD 6.79) and potassium 4.72 (SD 0.83). 25 (24%) patients had severe DKA with a mean age of 8.25 (SD 3.7). 7 patients were treated for cerebral edema, 16 had hypoglycemia and hypokalemia (8 each) during management. At least one risk factor for cerebral edema was identified in 92 patients. No mortality was found.

Conclusion: DKA poses significant risks of morbidity and mortality. It must be suspected and treated with fluids, insulin infusion, and careful monitoring for better outcomes.


Adriana Yock-Corrales, Mariela Gonzalez-Volio, Carlos Leiton, Fred Cavallo-Aita and Roberto Bogarin

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