Diabetic ketoacidosis in children and adolescents: Diagnostic and Therapeutic Pitfalls

A new study by Eirini Kostopoulou and team showed that in potentially deadly medical emergency, Diabetic ketoacidosis (DKA), accurate and speedy diagnosis, early management, and careful monitoring are crucial for breaking the cycle of life-threatening episodes and preventing serious sequelae in children and adolescents. The findings of this study were published in Diagnostics.

DKA is a common manifestation of Type 1 Diabetes Mellitus (T1DM) and, less frequently, Type 2 Diabetes Mellitus (T2DM) in children and adolescents. It is an immediate, severe consequence of relative insulin insufficiency. Acidemia, hyperglycemia, and/or ketonuria are the biochemical triads that describe it. Any physiological stress, including infections, can induce DKA, with gastroenteritis and urinary tract infections being the most common triggers. The current study seeks to increase knowledge of diagnostic and therapeutic pitfalls that make the best diagnostic and therapeutic response to this pediatric emergency fairly difficult, as well as a high index of suspicion surrounding them.

The Pubmed/Medline and Scopus databases, which include publications published from 2000 onwards, were used to perform a review of the literature. Differentiating between T1DM and T2DM, DKA and hyperosmolar hyperglycemic state (HHS), and DKA and alternative diagnoses presenting with overlapping symptoms, such as pneumonia, urinary tract infection, asthma exacerbation, acute abdomen, gastroenteritis, and central nervous system infection, are among the diagnostic challenges.

The key findings of this study were:

Making the distinction between type 1 and type 2 diabetes is one diagnostic problem. High body weight, Hispanic or African heritage, as well as family history of the condition and/or insulin resistance, are common among children with type 2 diabetes who are at risk for ketosis.

Their beta cells restart secreting insulin following therapy even if there is evidence of autoimmune. Ketosis was absent in hyperosmolar hyperglycemic state, a much deadlier condition.

For example, urinary tract infection, gastroenteritis, excessive activity, or a respiratory tract infection might all be confused for diabetic ketoacidosis.

A thorough history can show how the basic symptom triad progresses. Infection, however, may cause the disease to worsen. Beta-hydroxybutyrate, the primary ketone in diabetic ketoacidosis, was not picked up by nitroprusside testing.

Water balance and electrolyte concentrations must be closely monitored and often recorded during fluid resuscitation with 0.9% saline or lactated Ringer's.

Reference:

Kostopoulou, E., Sinopidis, X., Fouzas, S., Gkentzi, D., Dassios, T., Roupakias, S., & Dimitriou, G. (2023). Diabetic Ketoacidosis in Children and Adolescents; Diagnostic and Therapeutic Pitfalls. In Diagnostics (Vol. 13, Issue 15, p. 2602). MDPI AG. https://doi.org/10.3390/diagnostics13152602