Submitting/Presenting Author

Erica Zarse, Children's Mercy HospitalFollow

Presenter Status

Fellow

Abstract Type

Research

Primary Mentor

Dr. Sarah Tsai

Start Date

6-5-2022 11:30 AM

End Date

6-5-2022 1:30 PM

Presentation Type

Poster Presentation

Description

Background: Diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), and mixed DKA and HHS (hyperosmolar DKA) are hyperglycemic emergencies for which children with diabetes mellitus (DM) are admitted to the hospital. To date, there is little evidence to guide the management of pediatric diabetic patients with hyperosmolarity.

Objectives: The objective of this study is to compare the in-hospital complications at our institution in patients who have isolated DKA to those with a component of hyperosmolarity.

Methods: We reviewed medical records of patients from 01/2019 through 12/2020 admitted with DKA (serum bicarbonate ≤16 mEq/L) and/or HHS (blood glucose ≥600 mg/dL and osmolality ≥320 mOsm/kg). Patients transferred from an outside facility were excluded. Isolated HHS patients were combined with hyperosmolar DKA for analysis. We defined acute kidney injury (AKI) as an elevated creatinine level for age. We defined altered mental status (AMS) by any of the following: physician documented AMS in exam, Glasgow Coma Scale

Results: Three hundred sixty-nine admissions were evaluated: 334 (90.5%) had isolated DKA, 32 (8.7%) had hyperosmolar DKA, and 3 (0.8%) had isolated HHS. The median age of patients was 14 years (IQR 11.2-16.8) and 60% were female. Ninety-six percent of patients had type 1 DM; 4% had type 2 DM. Sixty-nine percent of patients had a known diagnosis of DM; 31% were new onset DM. Compared to isolated DKA patients, hyperosmolar patients had longer median lengths of hospital stay (37.4 vs 26.5 hours, p=0.0021), higher percentage admitted to the pediatric intensive care unit (71% vs 28%, p

Conclusions: In children with DM, hyperosmolarity increases acute complications compared to isolated DKA. Given the small number of patients with hyperosmolarity, data on a larger scale is needed. Our findings will be useful to guide interventional studies and identify ways to prevent acute complications.

MeSH Keywords

diabetic ketoacidosis; hyperglycemic hyperosmolar state; complications

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May 6th, 11:30 AM May 6th, 1:30 PM

Acute Complications in Pediatric Patients with Diabetes Admitted with Isolated Diabetic Ketoacidosis, Isolated Hyperglycemic Hyperosmolar State, and Mixed Hyperosmolar Diabetic Ketoacidosis

Background: Diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), and mixed DKA and HHS (hyperosmolar DKA) are hyperglycemic emergencies for which children with diabetes mellitus (DM) are admitted to the hospital. To date, there is little evidence to guide the management of pediatric diabetic patients with hyperosmolarity.

Objectives: The objective of this study is to compare the in-hospital complications at our institution in patients who have isolated DKA to those with a component of hyperosmolarity.

Methods: We reviewed medical records of patients from 01/2019 through 12/2020 admitted with DKA (serum bicarbonate ≤16 mEq/L) and/or HHS (blood glucose ≥600 mg/dL and osmolality ≥320 mOsm/kg). Patients transferred from an outside facility were excluded. Isolated HHS patients were combined with hyperosmolar DKA for analysis. We defined acute kidney injury (AKI) as an elevated creatinine level for age. We defined altered mental status (AMS) by any of the following: physician documented AMS in exam, Glasgow Coma Scale

Results: Three hundred sixty-nine admissions were evaluated: 334 (90.5%) had isolated DKA, 32 (8.7%) had hyperosmolar DKA, and 3 (0.8%) had isolated HHS. The median age of patients was 14 years (IQR 11.2-16.8) and 60% were female. Ninety-six percent of patients had type 1 DM; 4% had type 2 DM. Sixty-nine percent of patients had a known diagnosis of DM; 31% were new onset DM. Compared to isolated DKA patients, hyperosmolar patients had longer median lengths of hospital stay (37.4 vs 26.5 hours, p=0.0021), higher percentage admitted to the pediatric intensive care unit (71% vs 28%, p

Conclusions: In children with DM, hyperosmolarity increases acute complications compared to isolated DKA. Given the small number of patients with hyperosmolarity, data on a larger scale is needed. Our findings will be useful to guide interventional studies and identify ways to prevent acute complications.

 

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