Outcomes of children and adolescents admitted with diabetic ketoacidosis at Kenyatta national hospital between February 2013- February 2018.

Abstract

Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication that mainly occurs in patients with type 1 diabetes mellitus. Diabetic ketoacidosis (DKA) is the foremost cause of death in children with Diabetes mellitus (DM). Approximately 78000 children are diagnosed with diabetes each year, with a mortality rate of 0.15% - 0.31 % reported in industrialized nations. There is need to understand the DKA mortality rates in non-industrialized countries and associated factors. Recent data from developing countries report cerebral edema, sepsis, shock and renal failure as the main causes of death in DKA. Objectives: Primary objective: To determine proportion of children aged 0-18 years managed for DKA at KNH who were discharged home. Study Methods: This was a retrospective study carried out among 159 children (Ages 0– 18 years) admitted with DKA at Kenyatta National Hospital between February 2013 and February 2018. The study site was the central records department at KNH. Inclusion criteria was children aged 0-18 years admitted at KNH with diagnosis of DKA based on the ISPAD guideline biochemical criteria. Exclusion criteria Children with a clinician’s diagnosis of DKA but with missing data on some of the diagnostic parameters stated above. Data analysis Results: Out of 159 files reviewed the median age of 13 years with an IQR of 5, and 57% were females. Most of the participants had either severe DKA (40.9%) or moderate DKA (35.8%). Children discharged home were 93.1% while 6.9% died. The median duration of stay the general pediatric ward, adult ward and ICU was 10, 8 and 5 days respectively. Children who reported a temperature of above 37.5 degrees Celsius during the in-patient period were 88 (55.3%) while 25.7% had either high creatinine or decrease urine output. Conclusion: 1. 93.1% of the children admitted with DKA were discharged home. 2. The median duration of hospital stay was 8 days which was similar to that reported from previous studies. 3. Factors associated with death among children admitted with DKA were: increased creatinine/ decreased urine output, altered level of consciousness, severe severity of DKA, presence of fever, male gender and lack of HBA1C report in the 6 months preceding admission. Recommendation1. Need for admission in ICU for close monitoring to reduce mortality and morbidity. 2. There is need to closely monitor children with raised serum creatinine levels and decreased urine output as these are associated with poor clinical outcome in DKA 3. The study did not establish any significant association’s between missed insulin doses and poor short term outcomes probably due to the small sample size. Larger studies are required to validate these results.