Risk Factors for Adverse Outcomes in Children With Diabetic Ketoacidosis
By
Maha F Yousif
Katie D Dolak
Soumya Adhikari
Perrin C White
July 20, 2024
Clinical Scorecard: Identifying Risk Factors for Negative Outcomes in Pediatric Patients with Diabetic Ketoacidosis
At a Glance
Category Detail
Condition Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) in children Key Mechanisms Hyperglycemia, acidosis, and type 2 diabetes increase risk of adverse outcomes Target Population Pediatric patients admitted with DKA and/or HHS Care Setting Pediatric intensive care units and specialized inpatient floors in a large academic children's hospital
Key Highlights
Maximum serum glucose, initial pH, and diagnosis of type 2 diabetes strongly predict adverse outcomes. Adverse outcomes include death related to acute episode, ICU stay >48 hours, or transfer to higher-level ICU. Adverse outcomes increased during the COVID-19 pandemic and decreased after January 2022. Guideline-Based Recommendations
Diagnosis
Diagnose DKA by hyperglycemia (BG > 200 mg/dL), venous pH < 7.3 and/or bicarbonate < 18 mmol/L, and ketonemia. Diagnose HHS by blood glucose ≥ 600 mg/dL, serum osmolality ≥ 320 mOsm/kg, and venous pH > 7.25. Management
Treat DKA and HHS patients with intravenous insulin in ICU or specialized inpatient settings. Monitor patients closely for severity of hyperglycemia and acidosis to identify those at higher risk. Monitoring & Follow-up
Use maximum serum glucose and initial pH as key laboratory markers to assess risk. Track ICU length of stay and need for transfer to higher-level care as indicators of adverse outcomes. Risks
Type 2 diabetes is an independent risk factor for adverse outcomes in pediatric DKA/HHS. Severity of initial hyperglycemia and acidosis correlates with increased risk of death or prolonged ICU stay. Patient & Prescribing Data
Children admitted with DKA or HHS from 2010 to 2023 at a large pediatric hospital
Intravenous insulin treatment and early identification of high-risk patients based on glucose, pH, and diabetes type improve outcome prediction.
Clinical Best Practices
Develop and apply multivariable risk models incorporating serum glucose, pH, and diabetes type to predict adverse outcomes. Recognize increased risk during pandemic periods and adjust monitoring accordingly. Ensure ICU admission criteria include assessment of risk factors to optimize resource allocation. References
