Assessment of Clinical Profile, And Treatment Outcome of Diabetic Ketoacidosis among Diabetic Children, In Two Selected Hospital, Addis Ababa, Ethiopia, 2020

Abstract

Background: Diabetic ketoacidosis (DKA) is an acute and life-threatening situation that accounts for the majority of diabetes related morbidity and mortality in children and adolescents who suffer from type 1 diabetes mellitus (T1DM). Diabetic ketoacidosis is the most severe endocrine emergency in pediatrics, which is characterized by hyperglycemia (>250 mg/dl or 14 moll/l), metabolic acidosis (venous pH < 7.3), with associated glucosuria, ketonuria, and ketonemia. Objective: To assess the precipitating factors, clinical presentation, and treatment outcome of diabetic ketoacidosis among diabetic patients in two tertiary hospital of Addis Ababa. Methods: A retrospective analysis was done on the case records of 175 children with diabetic ketoacidosis admitted to our hospital from January 2015 to April 2020. They were managed using a standard protocol including intravenous fluids and insulin infusion. Blood glucose, serum electrolytes, blood urea, and urinary ketones were monitored at regular intervals. The outcomes were assessed. The data was checked for its ’ completeness and entered into Epi version 4.6, and imported to SPSS version 25 software for analysis. The Associations between independent and dependent variables were analyzed using binary logistic regression models. Result: The median age at presentation was 8 years ’ ranges from < 6 months to ≤ 12 years with male to female ratio of 1:1.5. One hundred thirtyseven children (78.3%) were detected to have diabetes mellitus at the time of presentation. Dehydration, Polyuria with polydipsia was the commonest clinical presentation. The precipitating factor of DKA was newly diagnosed, omission of insulin and infection respectively (137, 78.3%, 33, 21.7% and 5,2.9%). There was mortality which accounts 6.9%. Conclusion and Recommendation: DKA were most prevalent in newly diagnosed TIDM cases. Newly diagnosed T1DM and insulin omission were the main factors associated with DKA. The age of presentation and clinical symptoms of studied subjects were similar to international studies. High frequency of DKA at presentation of T1DM requires careful attention to issues of early diagnosis before development of ketoacidosis and subsequently need prevention of DKA management complication. We recommend all the health facilities to give health education about the sign and symptoms of DM and the acute complications of DM.