Original Contributions
Rate and prediction of infection in children with diabetic ketoacidosis,☆☆,

https://doi.org/10.1053/ajem.2001.24473Get rights and content

Abstract

The purpose of this retrospective cohort study was to determine the rate and prediction of infection in children, ≤ 21 years, with diabetic ketoacidosis (DKA). Over a 6-year period, 247 admissions were identified. There were 171 (69%) with no infection, 44 (17.8%) with presumed viral infection, and 32 (12.9%) with bacterial infection. The mean WBC for all patients was 17,519 ( ± 9,582). 118 (50%) had leukocytosis as defined by a WBC ≥15,000/mm3. WBC, differential, leukocytosis, as well as sex, temperature and new onset diabetes, were not significant predictors (P >.05) of bacterial infection. Bacterial infections were more common in children ≤3 years of age (P=.03). There was a significant correlation of WBC with both pH (r = −0.59, P<.001) and bicarbonate (r = −0.43, P<.001). In conclusion, most children in DKA have no evidence of infection. Leukocytosis is common but most likely reflects the severity of DKA rather than the presence of infection. (Am J Emerg Med 2001;19: 270-273. Copyright © 2001 by W.B. Saunders Company)

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.

References (11)

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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]

☆☆

Am J Emerg Med 2001;19: 270-273. Copyright © 2001 by W.B. Saunders Company

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