Original ContributionsRate and prediction of infection in children with diabetic ketoacidosis☆,☆☆,★
Section snippets
Methods
The study was conducted in an urban, university-affiliated children's hospital in northeastern United States. The records of children, up to and including the age of 21 years, who were admitted with the diagnosis of DKA between January 1, 1993 and December 31, 1998, were reviewed. The charts were identified by the ICD-9 admission and/or discharge codes of “Diabetic Ketoacidosis” and “Diabetes Mellitus.” In this review, DKA was defined by an elevated serum glucose ≥ 250 mg/dL, a serum
Results
During the time period of January 1993 through December 1998, there were 1,479 children admitted with diabetes mellitus; 1,429 (96.7%) patient charts were reviewed. Of these, 247 (17%) admissions were for DKA. The mean age of the patients was 10.7 ± 5.6 years; 44% were male. The mean admission glucose was 593 ± 280 mg/dL whereas the mean bicarbonate was 8.6 ± 3.6 meq/L and mean pH 7.15 ± 0.12. The mean admission white blood cell count was 17,519 ± 9,582/mm3; 50% had leukocytosis. The mean
Discussion
Early detection of bacterial infection in patients with diabetes mellitus is a clinical priority. This need is based on the higher morbidity associated with infections in adults with diabetes. Impaired host responses may be responsible for this increased severity of infection. For example, it has been shown that polymorphonuclear leukocytes in diabetic patients, particularly when acidosis is present, may have defects in adherence, chemotaxis, phagocytosis and antioxidant activity involved in
Conclusions
The majority of children in DKA have no clinical evidence of infection. Major bacterial infections, with potentially serious sequele, are particularly uncommon. Leukocytosis is commonly found but more likely reflects the severity of the ketoacidosis rather than the presence of infection. In the realm of clinical decision making, namely deciding which patients should receive antibiotics based on data available at initial presentation, we were unable to show an added benefit in using the
Acknowledgements
The authors thank Michael Shannon, MD, MPH for his assistance in preparing this manuscript.
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Managing Diabetic Ketoacidosis in Children
2021, Annals of Emergency MedicineCitation Excerpt :Measured serum sodium level should be corrected for the presence of hyperglycemia with the following formula: corrected sodium=measured sodium+[1.6 (glucose−100)/100]. A complete blood count is frequently obtained to evaluate for an infectious trigger for diabetic ketoacidosis but may demonstrate a nonspecific leukocytosis.8 In patients with abnormal serum potassium levels (either high or low), an electrocardiogram is indicated.
Diabetic ketoacidosis: A consensus statement of the Italian Association of Medical Diabetologists (AMD), Italian Society of Diabetology (SID), Italian Society of Endocrinology and Pediatric Diabetoloy (SIEDP)
2020, Nutrition, Metabolism and Cardiovascular DiseasesDiabetes Mellitus
2020, Sperling Pediatric Endocrinology: Expert Consult - Online and PrintBuilding bridges for innovation in ageing: Synergies between action groups of the EIP on AHA
2017, Journal of Nutrition, Health and AgingManagement of Diabetes in Children
2015, Endocrinology: Adult and PediatricDiabetic Ketoacidosis
2011, Pediatric Critical Care
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Address reprint requests to Vincent W. Chiang, MD, Division of Emergency Medicine, Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115. E-mail: [email protected]
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Am J Emerg Med 2001;19: 270-273. Copyright © 2001 by W.B. Saunders Company
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