Analysis of complications related to diabetic ketoacidosis in pediatric patients at a University Hospital – a cross-sectional study

INTRODUCTION: Diabetic ketoacidosis (DKA) is one the main complications of type 1 diabetes mellitus (DM1) and the leading cause of death among children and adolescents with the disease. The Medical hospital of Ribeirão Preto Medical School (HC-FMRP) is a reference in pediatric endocrinology and is responsible for most of the treatment of DKA cases in the Unified Health System. The objective of this study was to characterize the cases of DKA treated in that service and identify their most frequent complications. RESEARCH DESIGN AND METHODS: A cross-sectional descriptive study was carried out, based on the review of medical records of patients aged 0 to 16 years with a diagnosis of DKA treated between January 2016 and August 2020. RESULTS: Seventy-seven (77) admissions were analyzed. In relation to the total, 55.84% were diagnosed with a new case of DM1. The most affected age group was teenagers. An increase of 90.9% of cases between 2016 and 2020 was visualized. In HCFMRP, insulin therapy is performed subcutaneously. In the study, an increase in the need for insulin use was observed as the severity increased. Hypokalemia was the most frequent complication. There was cerebral edema in 11.69% of the cases, and cerebral edema was the cause of the only death, corresponding to a mortality rate of 1.29%. CONCLUSIONS: DKA incidence rates were higher than those reported in current guidelines. The number of cerebral edemas was also higher, but with lower mortality. It shows the effectiveness of subcutaneous insulin for treatment. An increase in the number of DKA cases was seen over the period, and more studies are needed to evaluate it. Other studies are also necessary to evaluate the difference in therapeutic conduction with subcutaneous and intravenous insulin. This study can contribute to improvement in the DKA management.