Ketoacidosis at presentation of type 1 diabetes mellitus in children: a retrospective 20-year experience from a tertiary care hospital in Serbia.

UNLABELLED: Diabetic ketoacidosis (DKA) has significant morbidity and mortality and is common at diagnosis in children. The aim of this study was to determine the frequency and clinical characteristics of DKA over a 20-year period among children diagnosed with type 1 diabetes mellitus (T1DM) at University children's hospital in Belgrade, Serbia. The study population comprised of 720 patients (366 boys) diagnosed with type 1 diabetes aged <18 years between January 1992 and December 2011. Of all patients diagnosed with T1DM, 237 (32.9 %) presented with DKA. The majority had either mild (69.6 %) or moderate (22.8 %) DKA. Sixty (55.0 %) of all children under 5 years had DKA compared to sixty-two (20.9 %) in the 5- to 10-year-old group and one hundred fifteen (36.6 %) in the 11- to 18-year-old patients (p<0.01), while 2.5 % of the entire DKA cohort were in real coma. During the later 10-year period, children less often had DKA at diagnosis compared with the earlier 10-year period (28.0 vs. 37.4 %) (p<0.01), but the frequency of severe DKA was higher in the age group <5 year and in the age group >11 year during 2002-2011, compared with the earlier 10-year period (12.9 vs. 3.4 %, p<0.01 and 17.1 vs. 3.8 %, p<0.01). CONCLUSION: The overall frequency of DKA in children with newly diagnosed type 1 diabetes decreased over a 20-year period at our hospital. However, children aged <5 years and adolescents are still at high risk for DKA at diagnosis.

[Nonclassic congenital adrenal hyperplasia resulting from 21-hydroxylase deficiency]. / Neklasicna kongenitalna adrenalna hiperplazija uzrokovana deficitom 21-hidrosilaze.

Nonclassic CAH, also termed as late onset of CAH, is a very mild form of 21-hydroxylase deficiency. The incidence of disease is estimated at 0.1% of population. Nonclassic CAH is usually diagnosed in the childhood before the age of 6 to 8 years as premature pubarche. The disease is not common in the infants and usually not before 6 to 8 months. This is a case report of 7-month female infant who was suspected of mild hyperandrogenism because of premature pubarche. The diagnosis was confirmed by mild basal elevation of 17-OHP (5.55 ng/ml) and characteristic hyper-response to ACTH, reaching values of 21 ng/ml, as well as accelerated bone maturation. The conventional treatment of NCAH was initiated, with glucocorticoid therapy (hydrocortisone) for one year and a half. After that period, our decision was to discontinue the hormonal therapy because of the impression that hyperandrogenism was mild (mild deficiency of the enzymes for steroid hormone synthesis). Child's growth, development and maturation are under constant control.

[New aspects of etiopathogenesis and clinical characteristics of diabetes mellitus type 1 in children]. / Noviji pogled na etiopatogenezu i klinicke odlike dijabetesa tip 1 u detinjsvu.

Apparent increase of the incidence of childhood diabetes mellitus has been observed in many countries over the last decades. Data of seasonality are not consistent, especially in younger group. The triggering of the autoimmune process in genetically susceptible individuals may be the result of a variety of environmental factors including viral infections, specific nutrients, early introduction of cow's milk proteins and ingestion of nitrosamines, stress-inducing events, early perinatal lesions. Clinical studies of the last decade have confirmed that diabetes mellitus in young children is specific type of type 1 diabetes. At presentation, children in preschool age group, who have type 1 diabetes, have higher incidence of ketoacidosis with coma because of immaturity of the central nervous system. Delays in diagnosis in small children often lead to more severe dehydration and ketoacidosis. Chi dren in the young age group who have type 1 diabetes represent unique set of problems for their families and health care team.