EC Paediatrics

Background: Diabetic ketoacidosis is the leading cause of morbidity and mortality in children with type 1 diabetes. DKA also can occur in children with type 2diabetes. DKA may occur in type 2 diabetes under conditions of extreme stress such as serious infection, trauma, cardiovascular or other emergencies, and, less often, as a presenting manifestation of type 2diabetes, a disorder called ketosis-prone diabetes mellitus.

Objective: This study was to evaluate of different sodium concentrations in children with Diabetic ketoacidosis.

Methods: This study was conducted on 60 children admitted to the PICU, Shebeen El-kom Teaching Hospital, with DKA including patients during August 2022 till April 2024. A written informed consent was obtained from the parents of all patients of the study. The study was approved by the Ethics Committee of Faculty of Medicine, Shebeen El-kom Teaching Hospital.

Results: in the current study, there were no significant differences between the four readings, changes and rate of change after 12^th hr. between the studied groups. On comparison inside each group: Group I, there were no significant differences between the four readings in group I regarding corrected Na+ level.

Conclusion: There was a significant decrease (RBG) or increase (blood pH, blood bicarbonate, serum K+, corrected Na+) throughout the study period inside each of groups I and II. There is need for further research on large scale patients in multicenter studies to investigate the ideal fluid concentrations used in the treatment of DKA and their effects-side effects.

 Keywords: Children; Concentrations; Diabetic Ketoacidosis; Na+; Rehydration

1. International Society for Pediatric and Adolescent Diabetes. ISPAD Consensus Guidelines for the Management of Type 1 diabetes Mellitus in Children and Adolescents”. Zeist, Netherlands, Medforum 5 (2014): 270-80.
2. Dobson L., et al. “Conventional measures underestimate glycaemia in cystic fibrosis patients”. Diabetic Medicine 21 (2004): 691-696.
3. Edge JA., et al. “The UK case control study of cerebral edema complicating diabetic ketoacidosis in children”. Diabetologia 49 (2006): 2002-2009.
4. Ham MR., et al. “Bedside ketone determination in diabetic children with hyperglycemia and ketosis in the acute care setting”. Pediatric Diabetes 5 (2004): 39.
5. Dunger DB., et al. “European Society for Pediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society consensus statement on diabetic ketoacidosis in children and adolescents”. Pediatrics 113 (2004): el33.
6. Glaser N., et al. “Risk Factors for Cerebral Edema in Children with Diabetic Ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics”. The New England Journal of Medicine 344 (2001): 264-269.
7. Hale PM., et al. “Factors predicting cerebral edema in young children with diabetic ketoacidosis and new onset type I diabetes”. Acta Paediatric 86 (2003): 626-631.
8. American Diabetes Association. “Diagnosis and classification of diabetes mellitus”. Diabetes Care 28 (2008): S37-S42.
9. Senay Savaş-Erdeve., et al. “Efficiency of fluid treatments with different sodium concentration in children with type 1diabetic ketoacidosis”. The Journal of Clinical Endocrinology and Metabolism 3 (2011): 149-153.
10. Toledo JD., et al. “Sodium concentration in rehydration fluids for children with ketoacidotic diabetes: Effect on serum sodium concentration”. The Journal of Pediatrics 154 (2009): 895-900.
11. Rother KI and Schwenk WF. “Effect of rehydration fluid with 75 mmol/L of sodium on serum sodium concentration and serum osmolality in young patients with diabetic ketoacidosis”. Mayo Clinic Proceedings 69 (1994): 1149-1153.
12. Montañana PA., et al. “The use of isotonic fluid as maintenance therapy prevents iatrogenic hyponatremia in paediatrics: a randomised, controlled open study”. Pediatric Critical Care Medicine 9 (2008): 589-597.