Presentation and precipitating factors of diabetic Ketoacidosis in children

ABSTRACT

Diabetes mellitus is a metabolic disorder caused by absolute or relative deficiency of insulin. It is the most common metabolic disorder of childhood and is caused by deficiency of insulin [type 1]. Its prevalence is 1 per 500-600 children. The incidence is 1.2-1.9 cases per 1000 children. The complications of diabetes are multiple and severe. Immediate complications include Diabetic Ketoacidosis [DKA] and Coma. 10-30% children present with DKA. The main contributing factor is relative lack of insulin. This occurs when there is increased requirement for insulin due to increased physiological stress as seen in infection, trauma, surgery and psychological stress, etc. [1] To identify the frequency of various presentations of DKA in children. [2] To identify the frequency of various precipitating factors of DKA in children. [3] To correlate the incidence of DKA with age and socioeconomic conditions. A cross-sectional study. JMDCH, January 2004 - October 2004. The convenient sample of 50 histories was collected from pediatric departments of various public and private sector hospitals of Karachi. Results were analyzed using MS Excel 2000. A total of 50 cases were analyzed out of which most of the cases were undiagnosed [64%] and belonged to low socioeconomic group [58%]. Mean age of male patients was significantly lower as compared to females [5.5 +/- 2.31 vs. 7.54 +/- 3.05, p<0.05], while status of hydrogen ion concentration [pH] was significantly lower in females [7.16 +/- 1.46 vs. 7.26 +/- 0.08, p<0.05]. Most frequent presenting complaints were vomiting, abdominal pain, dehydration and respiratory distress [34%]. The most frequent precipitating factor was fever in 17[34%] cases. More than half of the cases are undiagnosed and belong to low socioeconomic group. The level of awareness towards diagnosis of disease increases with the socioeconomic conditions. DKA affects both the genders equally; males being affected at an earlier age group. Most frequent presenting complaints are vomiting, abdominal pain, dehydration and respiratory distress while fever is the chief precipitating factor