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Research ArticleOriginal Article
Open Access

Clinical variables influencing the severity of diabetes ketoacidosis

Yara F. Alhamdani, Lojain O. Almadfaa and Abdulmoein E. AlAgha
Saudi Medical Journal May 2024, 45 (5) 502-509; DOI: https://doi.org/10.15537/smj.2024.45.4.20240058
Yara F. Alhamdani
From the Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
MBBS
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Lojain O. Almadfaa
From the Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
SBCP
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Abdulmoein E. AlAgha
From the Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
FRCPCH
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  • ORCID record for Abdulmoein E. AlAgha
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    Figure 1

    - The proportions of diabetes ketoacidosis (DKA) severity categories among patients under study.

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    Table 1

    - Demographic and diabetes-related characteristics by diabetes ketoacidosis (DKA) severity.

    ParameterOverall, N=156DKA severityP-value
    Mild n=47Moderate n=61Severe n=48
    Age category     
    Infant3 (1.9%)1 (2.1%)0 (0.0%)2 (4.2%)<0.001
    Toddler15 (9.6%)1 (2.1%)6 (9.8%)8 (16.7%) 
    Early childhood33 (21.2%)6 (12.8%)18 (29.5%)9 (18.8%) 
    Middle childhood84 (53.8%)37 (78.7%)26 (42.6%)21 (43.8%) 
    Early adolescence21 (13.5%)2 (4.3%)11 (18.0%)8 (16.7%) 
    Gender     
    Male84 (54.5%)25 (53.2%)35 (58.3%)24 (51.1%)0.778
    Female70 (45.5%)22 (46.8%)25 (41.7%)23 (48.9%) 
    Nationality     
    Saudi80 (51.9%)29 (61.7%)32 (53.3%)19 (40.4%)0.108
    Non-Saudi74 (48.1%)18 (38.3%)28 (46.7%)28 (59.6%) 
    Economic status     
    Good83 (53.2%)30 (63.8%)33 (54.1%)20 (41.7%)0.096
    Low73 (46.8%)17 (36.2%)28 (45.9%)28 (58.3%) 
    • View popup
    Table 2

    - Clinical presentation, associated diseases, and diabetes ketoacidosis severity (DKA).

    ParameterOverall, N=156DKA severityP-value
    Mild n=47Moderate n=61Severe, n=8
    Diabetes status     
    Known73 (47.1%)25 (53.2%)33 (54.1%)15 (31.9%)0.049
    New82 (52.9%)22 (46.8%)28 (45.9%)32 (68.1%) 
    Season     
    Winter34 (21.8%)9 (19.1%)13 (21.3%)12 (25.0%)0.190
    Spring28 (17.9%)8 (17.0%)14 (23.0%)6 (12.5%) 
    Summer45 (28.8%)11 (23.4%)22 (36.1%)12 (25.0%) 
    Autumn49 (31.4%)19 (40.4%)12 (19.7%)18 (37.5%) 
    DM duration of known T1DM patients     
    Years3.3 ± 2.53.5 ± 2.23.4 ± 2.82.9 ± 2.30.617
    Glycemic control of known T1DM patients     
    Good1 (1.4%)1 (4.8%)0 (0.0%)0 (0.0%)0.002
    Average14 (20.3%)9 (42.9%)5 (15.2%)0 (0%) 
    Poor54 (78.3%)11 (52.4%)28 (84.8%)15 (100%) 
    Presence of associated chronic disease     
    Yes25 (16.0%)9 (19.1%)11 (18.0%)5 (10.4%)0.436
    Type of associated chronic disease     
    ADHD6 (25.0%)3 (37.5%)2 (18.2%)1 (20.0%)0.829
    Autism2 (8.3%)0 (0.0%)1 (9.1%)1 (20.0%)0.682
    Celiac disease11 (45.8%)5 (62.5%)4 (36.4%)2 (40.0%)0.561
    G6PD deficiency2 (8.3%)0 (0.0%)2 (18.2%)0 (0.0%)0.681
    Hypothyroidism4 (16.7%)0 (0.0%)2 (18.2%)2 (40.0%)0.152
    Down syndrome1 (4.2%)0 (0.0%)1 (9.1%)0 (0.0%)>0.999
    CHD1 (4.2%)0 (0.0%)1 (9.1%)0 (0.0%)>0.999
    Nephrotic syndrome1 (4.2%)0 (0.0%)1 (9.1%)0 (0.0%)>0.999
    DKA duration     
    <24 hrs.k; <24 hours141 (90.4%)47 (100%)57 (93.4%)37 (77.1%)<0.001
    24 to 48 hours14 (9.0%)0 (0.0%)4 (6.6%)10 (20.8%) 
    >48 hours1 (0.6%)0 (0.0%)0 (0.0%)1 (2.1%) 
    • ADHD: attention deficit hyperactivity disorder, G6PD: glucose-6-phosphate dehydrogenase deficiency, CHD: congenital heart disease, T1DM: type 1 diabetes mellitus

    • View popup
    Table 3

    - Initial signs and symptoms, degree of dehydration, and diabetes ketoacidosis (DKA) severity.

    ParameterOverall N=156DKA severityP-value
    Mild n=47Moderate n=61Severe n=48
    Signs     
    Kassmaul breathing54 (34.6%)4 (8.5%)17 (27.9%)33 (68.8%)<0.001
    Tachycardia97 (62.2%)19 (40.4%)35 (57.4%)43 (89.6%)<0.001
    Glasgow Coma Scale14.6 ± 1.315.0 ± 0.014.9 ± 0.613.7 ± 2.0<0.001
    Fever15 (9.6%)3 (6.4%)8 (13.1%)4 (8.3%)0.488
    Polyphagia9 (5.8%)2 (4.3%)5 (8.2%)2 (4.2%)0.69
    Polydipsia79 (51.0%)22 (46.8%)33 (55.0%)24 (50.0%)0.693
    Polyuria84 (53.8%)24 (51.1%)32 (52.5%)28 (58.3%)0.747
    Blurry vision7 (4.5%)2 (4.3%)2 (3.3%)3 (6.3%)0.887
    Symptoms     
    Decreased activity97 (62.2%)21 (44.7%)34 (55.7%)42 (87.5%)<0.001
    Drowsiness58 (37.4%)7 (14.9%)13 (21.7%)38 (79.2%)<0.001
    Shortness of breath36 (23.1%)1 (2.1%)10 (16.4%)25 (52.1%)<0.001
    Vomiting113 (72.4%)24 (51.1%)47 (77.0%)42 (87.5%)<0.001
    Convulsion2 (1.3%)0 (0.0%)0 (0.0%)2 (4.2%)0.183
    Nausea25 (16.0%)4 (8.5%)13 (21.3%)8 (16.7%)0.197
    Diarrhea13 (8.3%)3 (6.4%)6 (9.8%)4 (8.3%)0.934
    Headache14 (9.0%)4 (8.5%)5 (8.2%)5 (10.4%)0.939
    Abdominal pain100 (64.5%)31 (66.0%)38 (63.3%)31 (64.6%)0.961
    Dehydration     
    Mild75 (48.4%)37 (80.4%)33 (54.1%)5 (10.4%)<0.001
    Moderate43 (27.7%)8 (17.4%)21 (34.4%)14 (29.2%) 
    Severe37 (23.9%)1 (2.2%)7 (11.5%)29 (60.4%) 
    • View popup
    Table 4

    - Laboratory evaluation and diabetes ketoacidosis (DKA) severity.

    ParameterOverall N=156DKA severityP-value
    Mild n=47Moderate n=61Severe n=48
    Corrected sodium     
    Hyponatremia40 (25.8%)13 (27.7%)18 (30.0%)9 (18.8%)0.001
    Normal102 (65.8%)34 (72.3%)40 (66.7%)28 (58.3%) 
    Hypernatremia13 (8.4%)0 (0.0%)2 (3.3%)11 (22.9%) 
    Corrected sodium, mmol/L138.0 ± 5.6136.6 ± 4.2137.2 ± 4.0140.4 ± 7.40.004
    Blood glucose, mg/dL433.9 ± 106.4408.7 ± 104.0424.2 ± 106.4470.8 ± 100.60.008
    White blood cells, count/uL15.2 ± 9.310.8 ± 5.911.6 ± 5.523.9 ± 10.1<0.001
    Hemoglobin g/dL13.3 ± 1.613.2 ± 1.413.4 ± 1.713.5 ± 1.70.517
    Platelet count, count/uL429.8 ± 136.1384.0 ± 120.4414.7 ± 135.3493.7 ± 130.3<0.001
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Clinical variables influencing the severity of diabetes ketoacidosis
Yara F. Alhamdani, Lojain O. Almadfaa, Abdulmoein E. AlAgha
Saudi Medical Journal May 2024, 45 (5) 502-509; DOI: 10.15537/smj.2024.45.4.20240058

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Clinical variables influencing the severity of diabetes ketoacidosis
Yara F. Alhamdani, Lojain O. Almadfaa, Abdulmoein E. AlAgha
Saudi Medical Journal May 2024, 45 (5) 502-509; DOI: 10.15537/smj.2024.45.4.20240058
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Keywords

  • type 1 diabetes
  • ketoacidosis
  • children
  • severity
  • clinical
  • presentation

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