Diabetic Ketoacidosisin Children with Type One Diabetes Mellitus: Risk Factors, Outcome and Complications

Background: Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type one diabetes mellitus (T1DM). Mortality is predominantly related to the occurrence of cerebral edema. Objective: The aim of the study is to identify the risk factors leading to the development of DKA and the complications associated with it to increase awareness of both physicians and general population. Materials and Methods: Data was collected from 99 patients admitted with the diagnosis of DKA to the pediatric ward at Al- Numan Teaching Hospital from January 2018 to December 2020. Diagnosis was based on both clinical and biochemical criteria. Information was taken regarding risk factors, outcome and complications. Results: Risk factors differ in patients with new onset diabetes from those with established T1DM. In new onset cases young age (less than 5 years) was the most important factor ( 42.8 % were in the age group 2 - 6 years). Regarding established cases insulin omission and poor metabolic control were the most important risk factors ( 65.3 % had poor control with omission of insulin doses). Regarding recurrent episodes of DKA adolescent females with behavioral problems or family problems were the highest risk group (85.7 %). There were no deaths in our study, 9 % developed complications related to hypoglycemia and electrolyte disturbances. One patient developed cerebral edema and one patient developed acute renal failure. Conclusion: like other studies, our study showed that risk factors differ depending on whether the patient had new onset or established T1DM. Young age was the most important risk factor for new onset cases while insulin omission and poor metabolic control was the most important risk factor in established cases. Most of the complications were due to electrolyte disturbances ( hyponatremia and hypokalemia) and hypoglycemia. Cerebral edema although occurring in less than 1 % of patients remains a devastating complication.