Management of Diabetic Ketoacidosis in Pediatric Intensive Care Unit

Background: In recent years, the incidence of type 1 diabetes has been increasing in children. The prognosis is related to acute metabolic complications, mainly ketoacidosis.

Methods: A retrospective descriptive study of patients admitted with inaugural ketoacidosis of type 1 diabetes to ICU of Pediatric Department in Fattouma Bourguiba Hospital of Monastir over 10-year period from 2008 to 2017. Results: A hospital incidence of the inaugural ketoacidosis was 2 per 1,000. The rate of the inaugural ketoacidosis among new diabetes cases was 22.52%. Fifty patients were collected: 23 girls and 27 boys. The mean age at admission was 6.6 ± 4.1 years. The mean time between the onset of symptoms and hospitalization was 15.51 ± 9.27 days. Polyuro-polydipsic syndrome and massive ketonuriawas found respectively in 98% and 82% of cases. Mean blood glucose at the time of diagnosis was 4.92 +/- 0.14 g/L. 16 children were treated according to modified Lestradet protocol and 34 childrenwere treated according to modified ISPAD protocol. Correction of blood glucose, ketonuria, pH and bicarbonates up to H8 were without significant difference between the two protocols (p>0.05). The most common complication in the acute phase was hypokalemia (8 cases). No cases of cerebral edema were observed.

Conclusion: The inaugural ketoacidosis in children remains common in our region. Early diagnosis of type 1 diabetes is important to prevent complications.