Clinical profile and outcomes of paediatric patients with diabetic ketoacidosis at a tertiary care hospital in Pakistan

Objectives: This study aims to present an experience in the management and clinical features of 88 children presenting with diabetic ketoacidosis (DKA) from Pakistan. Methods: A retrospective medical chart review of all patients, ≤ 15 years of age, who presented to the Aga Khan University Hospital, Karachi, Pakistan in the last ten years with a diagnosis of diabetic ketoacidosis was carried out. Severity of DKA was defined as mild (venous pH<7.30 or bicarbonate=15mEq/l), moderate (venous pH<7.2 or bicarbonate= 10 mEq/l) and severe (venous pH <7 or bicarbonate < 5 mEq/l). These classes correspond to 1st, 2nd and 3rd degrees of diabetic ketoacidosis severity respectively. Cases in which diabetic ketoacidosis had occurred at onset of diabetic diagnosis were not included in the study. Results: Mean age was 7.5 ± 3.6 years; 58 (66%) patients were male. Twenty six patients had mild diabetic ketoacidosis, 44 had moderate while 18 had severe diabetic ketoacidosis at the time of presentation. Severity of diabetic ketoacidosis was significantly associated with the presence of infection, history of omission of insulin, poor compliance, presence of shock at time of presentation, length of stay in the hospital, final outcome (p < 0.01 for each of these associations) and Glasgow Coma Scale score (p=0.02). Mortality in this series was 3.4%. Conclusion: Poor compliance was associated with the severity of diabetic ketoacidosis. Paediatric endocrinologists should ensure that patients and their parents understand the importance of the need for regular insulin injections and regular monitoring of blood glucose.