Pediatric Diabetic Ketoacidosis: A Retrospective Study on Triggering Factors and Complications in a Turkish Intensive Care

INTRODUCTION: Diabetic ketoacidosis (DKA) is a critical, potentially life-threatening complication of diabetes mellitus in children, characterized by hyperglycemia, acidosis, and ketonemia/ketonuria. Despite known risk factors and mortality rates, few studies have focused on the pediatric population, especially in specific regions under standard treatment protocols. This study investigates the demographic, clinical, and laboratory characteristics of children with DKA, identifies triggering factors and factors affecting DKA severity and complications, and evaluates the outcomes of a standardized treatment protocol in a Turkish Pediatric Intensive Care Unit (PICU).
METHODS: In this single-center retrospective study at G. Hospital's PICU, we included 115 children diagnosed with DKA between 2015 and 2022, following the DKA Treatment Protocol of the Turkish Society of Pediatric Emergency and Intensive Care Medicine and the International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines. We analyzed patients’ demographic, clinical, and laboratory characteristics, treatment outcomes, and complications using SPSS 25.0.
RESULTS: The sample primarily consisted of female patients and those newly diagnosed with diabetes mellitus (DM), with a median age of 110 months. The mortality rate was low at 0.87%, with one death due to sepsis-induced multiple organ failure. DKA severity (lower GCS, younger age, electrolyte imbalance, acidosis, complications) correlated with longer PICU stay and recovery in children. The findings also highlighted the standardized treatment protocol's effectiveness in managing DKA and reducing complications.
DISCUSSION AND CONCLUSION: The study underscores the importance of early diagnosis, standardized treatment protocols, and comprehensive care in pediatric DKA management. It emphasizes the need for ongoing education and awareness among healthcare providers and caregivers to prevent DKA and its severe outcomes. Further multicenter studies are necessary to extend these findings to the broader pediatric population and refine DKA management strategies.