https://imcjms.com/public Ibrahim Medical College Journal of Medical Science https://imcjms.com/public/registration/journal_full_text/110 Sun, 09 Oct 2016 11:37:58 +0000 Abstract Ibrahim Med. Coll. J. 2008; 2(1): 17-20 Key words: Ketosis, children, diabetes, BIRDEM Introduction BIRDEM is a tertiary level referral hospital. It is expected that childhood diabetics who visit this hospital represent the population (childhood diabetics) of Bangladesh as patients come to this hospital from almost all parts of the country.In this study we have reviewed the experience of a major paediatric diabetes care service over the last five years in respect of admissions for DKA, its etiology and outcome. Methods Results have been reported as mean ± SD. The detailed case records of the children were analyzed by SPSS programme. A p value of less than .05 was considered to be significant. Results         The median duration of polyuria and/or polydipsia varied between newly diagnosed and known diabetics (3.2 - 25d) (p<.001). Among other symptoms, 57.8 % had vomiting and 35.7% had abdominal pain. All patients presented with altered levels of consciousness and 35 (67.3%) were unconscious of different grades. Table-1: Glycaemic status in two groups Group I RBS 24 ± 8.4 13.8 ± 2.9   Blood urea was higher in the newly diagnosed patients but was not significant between the two groups (p<.738). Serum creatinine was higher in group I than group II (p<.031). Cholesterol level was also higher in group I than group II (p<.034). Mean pH was 7.18 ± 0.14 and HCO3 was 8.94 ± 6.6. There was no statistical difference between two groups. Complications noted were acute renal failure and cerebral edema. Three patients developed acute renal failure which improved after peritoneal dialysis. There were four episodes of cerebral oedema with two associated deaths. Table-2: Cause of deaths in children with DKA Group I Septicaemia 2 1 Cerebral oedema 1 2     This study provides a different picture regarding types of diabetes presenting with DKA. One FCPD and three secondary types presented with DKA which is different compared to the western world where mostly type 1 diabetic children present with DKA9. The frequency of DKA at onset of diabetes varies considerably from country to country. In our study, half of the patients presented with ketoacidosis which is similar to different studies where 25% to 40% of children are newly diagnosed10,11. Amongst the precipitating causes, infection was the commonest (50%) which is similar to a study in Sudan where acute infections accounted for 38% of the episodes12. In our study those in the age range 10-14 years suffered from DKA which was significant between the two groups and the mean age was 11.2 ± 4.4 years. The percentage of DKA cases in boys and girls is usually considered to be the same11,13. In our study, girls faced an increased risk of developing DKA at onset of diabetes mellitus. A study from Australia was analogous in many ways: Bui et al.14 found a ratio of 1.3:1.0 in newly diagnosed patients with DKA. Whilst newly diagnosed patients appeared to have a very short duration (3.2 days) of polyuria and polydispia, the known diabetics had a longer duration (25 days) in our study. Approximately 50% of the newly diagnosed patients had experienced polyuria and/or polydipsia for more than 2 wks14. The outcome of treatment in the whole group was good in 46 (86.7%) patients who recovered without complications. Five patients died, the causes of death being septicaemia (n= 2), cerebral oedema (n-2) and pneumonia (n=1). There was no significant difference in between the two groups regarding outcome (p< .707). Sepsis and cerebral oedema have been reported as cause of death in DKA patients in India22. Conclusion   1.   Scibilia J, Finegold D, Dorman J, Becker D, Drash A. 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