Background : Diabetic ketoacidosis (DKA) is a leading complication of type-1 Diabetes Mellitus (T1DM) which mostly affects children. In Indonesia, there is a lack of clinical and biochemical characteristics of these patients. Our aim is to describe the clinical and laboratory data of DKA in T1DM children.
Material : We reviewed 13 cases of 11 children aged 5-18 years diagnosed with DKA and T1DM retrospectively in Cipto Mangunkusumo Hospital, from January 2017-April 2018. Medical history and laboratory data were obtained. DKA was classified into mild, moderate, and severe based on pH and HCO3 levels.
Results : Thirteen cases from 11 children with DKA were obtained. The median of age was 12(0-15) years. Only three patients had a family history of DM. Four patients (30.7%) had DKA at presentation of T1DM, and nine cases (69.2%) had histories of previous DKA. More than half of the cases had classical symptoms of DM (69.4%), dyspnea (69.2%), and nausea or vomiting (61.5%). The average length of stay was 3(1-17) days; one patient was an infant with comorbidites thus needing longer care. Most subjects had moderate-severe DKA (61.5%), with the mean pH and HCO3 of 7.18 (0.18) and 5.15 (5.51). Mean blood glucose, HbA1c levels, and serum ketone at arrival were 688.76 (454-1113.6) g/dL, 12.1 (6.8-13.8), and 3.23 (1.14) respectively. The mean electrolyte levels were in normal range. Leukocytosis and thrombocytosis were found in most patients. All patients recovered from DKA, there were no deaths.
Conclusions : Incidence of DKA at presentation of T1DM remains high, as well as reoccurrence of DKA in previously diagnosed T1DM patients. Dyspnea, classical symptoms, and nausea or vomiting were the most common symptoms. Most patients had moderate-severe DKA based on laboratory values. The average length of stay was three days, which is needed to treat DKA and educate caregivers on long-term care of T1DM.