Relationships among biochemical measures in children with diabetic ketoacidosis

Author:

Glaser Nicole S.1,Stoner Michael J.2,Kwok Maria Y.3,Quayle Kimberly S.4,Brown Kathleen M.5,Schunk Jeff E.6,Trainor Jennifer L.7,McManemy Julie K.8,Tzimenatos Leah9,Rewers Arleta10,Nigrovic Lise E.11,Bennett Jonathan E.12,Myers Sage R.13,Smith McKenna6,Casper T. Charles6,Kuppermann Nathan19

Affiliation:

1. Department of Pediatrics , University of California, Davis Health, University of California Davis, School of Medicine , Sacramento , USA

2. Division of Emergency Medicine, Department of Pediatrics , Nationwide Children’s Hospital, The Ohio State University School of Medicine , Columbus , USA

3. Division of Emergency Medicine, Department of Pediatrics , New York Presbyterian Morgan Stanley Children’s Hospital, Columbia University College of Physicians and Surgeons , New York , USA

4. Division of Emergency Medicine, Department of Pediatrics , St. Louis Children’s Hospital, Washington University School of Medicine in St. Louis , Saint Louis , USA

5. Division of Emergency Medicine, Department of Pediatrics , Children’s National Medical Center, The George Washington School of Medicine and Health Sciences , Washington DC , USA

6. Department of Pediatrics , University of Utah School of Medicine , Salt Lake City , USA

7. Division of Emergency Medicine, Department of Pediatrics , Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine , Chicago , USA

8. Division of Emergency Medicine, Department of Pediatrics , Texas Children’s Hospital, Baylor College of Medicine , Houston , USA

9. Department of Emergency Medicine , University of California Davis Health, University of California Davis, School of Medicine , Sacramento , USA

10. Division of Emergency Medicine, Department of Pediatrics , The Colorado Children’s Hospital, University of Colorado-Denver School of Medicine , Denver , USA

11. Division of Emergency Medicine, Department of Pediatrics , Boston Children’s Hospital, Harvard Medical School , Boston , USA

12. Division of Emergency Medicine , Nemours/A.I. DuPont Hospital for Children, Sidney Kimmel Medical College at Thomas Jefferson University , Philadelphia , USA

13. Division of Emergency Medicine, Department of Pediatrics , Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania , Philadelphia , USA

Abstract

Abstract Objectives Investigating empirical relationships among laboratory measures in children with diabetic ketoacidosis (DKA) can provide insights into physiological alterations occurring during DKA. We determined whether alterations in laboratory measures during DKA conform to theoretical predictions. Methods We used Pearson correlation statistics and linear regression to investigate correlations between blood glucose, electrolytes, pH and PCO2 at emergency department presentation in 1,681 pediatric DKA episodes. Among children with repeat DKA episodes, we also assessed correlations between laboratory measures at the first vs. second episode. Results pH and bicarbonate levels were strongly correlated (r=0.64), however, pH and PCO2 were only loosely correlated (r=0.17). Glucose levels were correlated with indicators of dehydration and kidney function (blood urea nitrogen (BUN), r=0.44; creatinine, r=0.42; glucose-corrected sodium, r=0.32). Among children with repeat DKA episodes, PCO2 levels tended to be similar at the first vs. second episode (r=0.34), although pH levels were only loosely correlated (r=0.19). Conclusions Elevated glucose levels at DKA presentation largely reflect alterations in glomerular filtration rate. pH and PCO2 are weakly correlated suggesting that respiratory responses to acidosis vary among individuals and may be influenced by pulmonary and central nervous system effects of DKA.

Funder

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Maternal and Child Health Bureau

Publisher

Walter de Gruyter GmbH

Subject

Endocrinology,Endocrinology, Diabetes and Metabolism,Pediatrics, Perinatology and Child Health

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