DIABETIC KETOACIDOSIS IN CHILDHOOD

Abstract

Diabetic ketoacidosis (DKA) is an emergency condition first described in 1886. It develops as a result of an absolute or relative deficiency of circulating insulin and the combined effects of elevated levels of counter-insular hormones. According to literature data, diabetes mellitus type 1 accounts for 10% of the total incidence, but it is the most common type of diabetes in children and young adults. Each year, the incidence of type 1 DM increases by about 3% and is increasingly common in the under-15 age group. The incidence of diabetic ketoacidosis at diagnosis of diabetes varies widely geographically (15%-70%) for Europe and North America. As the debut of diabetes, DKA occurs more often in children under two years of age. Complications associated with the treatment of diabetic ketoacidosis are cerebral edema and hypoglycemia. Epidemiological data indicate that cerebral edema develops in 0.5-0.9% of ketoacidosis with a mortality rate of 21-24%. Some literature data indicate mortality in DKA as high as 31%. Memory deficits were observed in surviving children. Objective: To investigate risk factors for DKA in childhood and compare with literature data. Мaterial and methods: The study covers the period January 2021 - March 2024. 59 children aged from 0 to 18 years, hospitalized in the Pediatric Department of UMBAL "Kanev" AD, city of Ruse. Documentary and statistical methods were used. Conclusions: 1. Newly diagnosed children with the debut of DKA was observed in 34.2% of all cases with ketoacidosis, which shows an increase in cases compared to literature data. 2. A negative trend is observed in hospitalized children with DKA - 64.4%, which is more than half of hospitalized children. 3. 50.8% of hospitalized children with diabetes were admitted in a severe and very severe general condition, which is due to rapidly progressing dehydration and metabolic acidosis. 4. The onset of diabetes with ketoacidosis is present in 34.2% of the cases of children admitted with ketoacidosis, and in 65.8% of them the hospitalization is consecutive to the onset of ketoacidosis as a result of a preceding acute viral infection. 5. 64.4% were discharged with improvement in general condition, and 30.5% in good general condition, which is an indicator of adequate treatment. Conclusion: DKA still leads to childhood mortality, and recurrent DKA is an important indicator of the socioeconomic level of a region and of diabetes care. Modern treatment of diabetes, with the possibilities of maintaining good metabolic control in childhood and adolescence, aims at normal physical and neuropsychological development of the child, complete social adaptation in society, distancing and reducing the degree of late complications.