diabetestalk.net

Diabetic Ketoacidosis Acute Kidney Injury

Acute Kidney Injury In Children With Type 1 Diabetes Hospitalized For Diabetic Ketoacidosis.

Acute Kidney Injury In Children With Type 1 Diabetes Hospitalized For Diabetic Ketoacidosis.

Abstract Importance: Acute kidney injury (AKI) in children is associated with poor short-term and long-term health outcomes; however, the frequency of AKI in children hospitalized for diabetic ketoacidosis (DKA) has not been previously examined. Objectives: To determine the proportion of children hospitalized for DKA who develop AKI and to identify the associated clinical and biochemical markers of AKI. Design, Setting, and Participants: This medical record review of all DKA admissions from September 1, 2008, through December 31, 2013, was conducted at British Columbia Children's Hospital, the tertiary pediatric hospital in British Columbia, Canada. Children aged 18 years or younger with type 1 diabetes and DKA and with complete medical records available for data analysis were included (n = 165). All data collection occurred between September 8, 2014, and June 26, 2015. Data analysis took place from August 25, 2015, to June 8, 2016. Main Outcomes and Measures: Acute kidney injury was defined using Kidney Disease/Improving Global Outcomes serum creatinine criteria. Multinomial logistic regression was used to identify potential factors associated with AKI. Results: Of the 165 children hospitalized for DKA, 106 (64.2%) developed AKI (AKI stage 1, 37 [34.9%]; AKI stage 2, 48 [45.3%]; and AKI stage 3, 21 [19.8%]). Two children required hemodialysis. In the adjusted multinomial logistic regression model, a serum bicarbonate level less than 10 mEq/L (compared with ≥10 mEq/L) was associated with a 5-fold increase in the odds of severe (stage 2 or 3) AKI (adjusted odds ratio [aOR], 5.22; 95% CI, 1.35-20.22). Each increase of 5 beats/min in initial heart rate was associated with a 22% increase in the odds of severe AKI (aOR, 1.22; 95% CI, 1.07-1.39). Initial corrected sodium le Continue reading >>

Original Article Clinical Outcomes Of Septic Patients With Diabetic Ketoacidosis Between 2004 And 2013 In A Tertiary Hospital In Taiwan

Original Article Clinical Outcomes Of Septic Patients With Diabetic Ketoacidosis Between 2004 And 2013 In A Tertiary Hospital In Taiwan

Infection is the most common predisposing factor for diabetic ketoacidosis (DKA); however, studies are rare that have investigated the clinical outcomes of septic patients with infection-precipitated DKA. A retrospective cohort study was conducted at a tertiary hospital from 2004 to 2013. Patients with DKA in whom the presence of a predisposing infection was confirmed were enrolled. Characteristics at initial presentation, primary infection sources, and causative microorganisms were compared between the nonacute kidney injury (non-AKI) group and acute kidney injury (AKI) group at each stage. Risk factors for the development of failure-stage AKI and its outcomes were also analyzed. One hundred and sixty DKA episodes were assessed. The most common infection sites were the urinary and respiratory tracts. The leading causative microorganism was Escherichia coli, followed by Klebsiella pneumoniae. A complicated/severe infection state [odds ratio (OR), 15.27; p < 0.001] and a high level of C-reactive protein (OR, 1.012; p < 0.001) were independently associated with bacteremia. Corrected sodium (Na; OR, 1.062; p = 0.039), initial plasma glucose (OR, 1.003; p = 0.041), severe grade of DKA (OR, 13.41; p = 0.045), and the Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR, 1.08; p = 0.033) were identified as independent risk factors for the development of failure-stage AKI among septic patients with infection-precipitated DKA. Patients with failure-stage AKI had a higher frequency of incomplete recovery of renal function (20.4% of patients in failure vs. 5.9% of patients in risk and injury, p = 0.009). Bacteremia independently predicted the absence of complete recovery of renal function (OR, 5.86; p = 0.038). For patients with infection-precipitated DKA, the cli Continue reading >>

Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

Go to: Introduction The incidence of diabetes mellitus is increasing worldwide affecting both types of the disease. The most frequent acute diabetic complications are hyperglycemic crises, namely diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state. Diabetic ketoacidosis results from an absolute insulin deficiency. Classical presentation associates a triad of uncontrolled hyperglycemia, metabolic acidosis and high ketone bodies concentration. Similarly to diabetes, the incidence of DKA increases over time [1], [2]. This may be a life-threatening condition due to severe clinical and biological impairments and treatment associated complications (cerebral edema, acute respiratory distress syndrome, hypokalaemia, hypophosphatemia). However, mortality is low and most of the time, death is related to the precipitating factor [3]–[6]. For this reason, admission of these patients in ICU is still debated. A grading system for severity of DKA was described previously [7]. Patients presenting the most severe grades or common severity criteria were considered for ICU admission. However this grading system is not recommended for clinical practice, resulting in wide variations in ICU utilisation for DKA, depending on the national practices, the number of DKA admitted in the units and the severity of the clinical status [8]. Interestingly, in the absence of randomised trials, there are no data showing any impact of the level of care on DKA mortality. To help clinicians, guidelines for DKA management are published and updated by the American Diabetic Association [6]. Their effect on clinical outcome is unclear as compliance to guidelines is poor in diabetes care and ICU [9], [10]. However, implementation of a local mandatory protocol seems more efficient to decrease ICU a Continue reading >>

Acute Kidney Injury As A Severe Complication Of Diabetic Ketoacidosis In Children: A Case Report

Acute Kidney Injury As A Severe Complication Of Diabetic Ketoacidosis In Children: A Case Report

Background Diabetic Ketoacidoasis (DKA) is associated with significant morbidity and mortality and probably could be prevented by earlier diagnosis of diabetes mellitus (DM) and intervention. The level alertness of primary care doctors and knowledge on DM play a role to prevent severe complication of DKA. Methods We reported a diabetic ketoacidosis patient developing acute kidney injury at Hasan Sadikin General Hospital Bandung, Indonesia. Results A 12-year-old girl from a rural area was admitted to our pediatric emergency with decreased consciousness. We reviewed there was a history of polyuria, polydipsia and marked weight loss. When she arrived at hospital, she was very ill, comatose state, severe dehydration and typical Kussmaul breathing. Her heart rate was 140/min with thread pulse, low blood pressure, dry mucous membranes, sunken eyes, poor capillary return, and cold fingers. Laboratory analysis showed her blood glucose level was 890 mg/dl, severe metabolic acidosis and urine ketones 3+. The patient was resuscitated with iv fluid as soon as possible, followed by insulin and potassium chloride. On day 2 she developed oliguric and her serum creatinin and urea levels were 2.25 and 124 mg/dl that impressed as acute kidney injury. After fluid restriction she had persistent oliguric, increased serum creatinin and urea up to 7.34 and 234 mg/dl warranted initiation of peritoneal dialysis. After peritoneal dialysis and DKA management she showed a good improvement. Continue reading >>

Diabetic Ketoacidosis With Acute Kidney Injury In Prepubertal Children: A Report On Two Cases

Diabetic Ketoacidosis With Acute Kidney Injury In Prepubertal Children: A Report On Two Cases

Diabetic ketoacidosis with acute kidney injury in prepubertal children: a report on two cases Type 1 diabetes mellitus is a result of autoimmune damage, in which environmental factors are thought to trigger the autoimmune destruction of pancreatic -cells.1,2 Worldwide, an estimated 65,000 children under 15 years of age develop type 1 diabetes mellitus each year.3 Approximately 30% of children who present with newly-diagnosed type 1 diabetes have diabetic ketoacidosis (DKA).4 Himawan et al. reported a DKA prevalence of43.6% in girls.5 The long-term effects of diabetes mellitus include retinopathy, chronic kidney disease (nephropathy), neuropathy, and dyslipidemia.2 Andriyani D, Wahyudhi A, Anggriawan S. Diabetic ketoacidosis with acute kidney injury in prepubertal children: a report on two cases. PI [Internet]. 16Jan.2017 [cited 5May2018];56(6):360-. Available from: This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License . Authors who publish with this journal agree to the following terms: Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under aCreative Commons Attribution Licensethat allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. 1. Hay WW, Levin MJ, Deterding RR, Abzug MJ, Sondheimer JM. Current diagnosis and treatment pediatrics. In: Rewers M, Chase HP, Eisenbarth GS, editors. Diabetes Continue reading >>

Many Children In Dka Experience Acute Kidney Injury

Many Children In Dka Experience Acute Kidney Injury

A study finds more than half of children with Type 1 exhibit the symptoms. Kidney disease is often viewed as a potential long-term complication for Type 1 diabetes. A new study suggests, however, that even a single bout of diabetic ketoacidosis (DKA) may injure the kidneys of children. sponsor For the study, researchers with the University of British Columbia and British Columbia Children’s Hospital reviewed the medical records of 165 children with Type 1 diabetes who had been hospitalized for DKA. Out of this group, 106 children were found to also have experienced acute kidney injury, with two children needing dialysis to treat the condition, according to findings published in JAMA Pediatrics. Acute kidney injury was diagnosed using a blood test to measure the buildup of creatinine, a waste product expelled by the kidneys. Learn more about DKA by reading the article “How DKA Happens and What to Do About it.” According to the National Kidney Foundation, acute kidney injury can be asymptomatic or have a variety of symptoms. Potential symptoms can include a decrease in urination, swelling around legs, ankles, and eyes, fatigue, and chest pain. While acute kidney injury often can be effectively treated in the hospital, it’s considered a risk factor for future stroke, heart disease, and kidney disease; acute kidney injury even ups the risk of future acute kidney injury. The National Kidney Foundation recommends that those who experience acute kidney injury should inform their healthcare providers about it so they can screen kidney health and function. To do this, though, the injury must be properly diagnosed at the time it occurs. sponsor An audit found the risk of DKA during hospitalization was too high. Read more here. DKA taxes the kidneys in a number of ways. Hi Continue reading >>

Acute Kidney Injury In Children With Type 1 Diabetes Hospitalized For Diabetic Ketoacidosis

Acute Kidney Injury In Children With Type 1 Diabetes Hospitalized For Diabetic Ketoacidosis

Abstract: Importance Acute kidney injury (AKI) in children is associated with poor short-term and long-term health outcomes; however, the frequency of AKI in children hospitalized for diabetic ketoacidosis (DKA) has not been previously examined. Objectives To determine the proportion of children hospitalized for DKA who develop AKI and to identify the associated clinical and biochemical markers of AKI. Design, Setting, and Participants This medical record review of all DKA admissions from September 1, 2008, through December 31, 2013, was conducted at British Columbia Children’s Hospital, the tertiary pediatric hospital in British Columbia, Canada. Children aged 18 years or younger with type 1 diabetes and DKA and with complete medical records available for data analysis were included (n = 165). All data collection occurred between September 8, 2014, and June 26, 2015. Data analysis took place from August 25, 2015, to June 8, 2016. Main Outcomes and Measures Acute kidney injury was defined using Kidney Disease/Improving Global Outcomes serum creatinine criteria. Multinomial logistic regression was used to identify potential factors associated with AKI. Results Of the 165 children hospitalized for DKA, 106 (64.2%) developed AKI (AKI stage 1, 37 [34.9%]; AKI stage 2, 48 [45.3%]; and AKI stage 3, 21 [19.8%]). Two children required hemodialysis. In the adjusted multinomial logistic regression model, a serum bicarbonate level less than 10 mEq/L (compared with ≥10 mEq/L) was associated with a 5-fold increase in the odds of severe (stage 2 or 3) AKI (adjusted odds ratio [aOR], 5.22; 95% CI, 1.35-20.22). Each increase of 5 beats/min in initial heart rate was associated with a 22% increase in the odds of severe AKI (aOR, 1.22; 95% CI, 1.07-1.39). Initial corrected sodium leve Continue reading >>

Diabetic Ketoacidosis Increases Risk Of Acute Renal Failure In Pediatric Patients With Type 1 Diabetes

Diabetic Ketoacidosis Increases Risk Of Acute Renal Failure In Pediatric Patients With Type 1 Diabetes

Condition often under-recognized, yet preventable and treatable. Diabetic ketoacidosis (DKA) is a syndrome presenting in people with diabetes when insulin utilization is markedly diminished, whether via sudden increases in insulin requirements (most often due to acute illness) or sharp decreases in exogenous insulin administration (sudden cessation, for example). DKA is manifested as severe hyperglycemia, systemic acidosis, and severe dehydration due to rapidly increasing osmotic diuresis. This condition is especially worrisome in the pediatric diabetic population, as the resulting risk of renal injury often goes unrecognized at presentation. In 2014, the results of the SEARCH for Diabetes in Youth Study suggested that approximately 30% of pediatric (<18 y.o.) type 1 diabetes patients presented with DKA at initial diagnosis. Other studies have looked at the treatment of DKA in the pediatric population, and its effects on morbidity and mortality, but until now, none have attempted to correlate DKA and acute renal failure. The current issue of JAMA Pediatric presents a study looking at the incidence of acute kidney injury in pediatric patients hospitalized for DKA and attempts to show a correlation between the two events. This retrospective review collected data on pediatric T1D patients admitted to the British Columbia Children’s Hospital with DKA between September 2008 and December 2013. Patients with the above mentioned conditions and complete medical records during that period were included. The primary objective was to determine the proportion of eligible subjects who developed acute kidney injury (AKI). During the prescribed time frame, 211 children were hospitalized at BCCH with DKA. Of these, 165 admissions met criteria for the study. Demographically, 53.9% were Continue reading >>

Severe Acute Renal Failure In A Patient With Diabetic Ketoacidosis

Severe Acute Renal Failure In A Patient With Diabetic Ketoacidosis

1 King Khalid National Guard Hospital, Jeddah, Kingdom of Saudi Arabia, Department of Pediatrics, Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Canada, Canada 2 Department of Pediatrics, Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Canada Click here for correspondence address and email Acute renal failure (ARF) is a rare but potentially fatal complication of diabetic ketoacidosis (DKA). Early recognition and aggressive treatment of ARF during DKA may improve the prognosis of these patients. We present a case report of a 12 year old female admitted to the hospital with severe DKA as the 1s t manifestation of her diabetes mellitus. She presented with severe metabolic acidosis, hypophosphatemia, and oliguric ARF. In addition, rhabdomyolysis was noted during the course of DKA which probably contributed to the ARF. Management of DKA and renal replacement therapy resulted in quick recovery of renal function. We suggest that early initiation of renal replacement therapy for patients with DKA developing ARF may improve the potentially poor outcome of patients with ARF associated with DKA. How to cite this article: Al-Matrafi J, Vethamuthu J, Feber J. Severe acute renal failure in a patient with diabetic ketoacidosis. Saudi J Kidney Dis Transpl 2009;20:831-4 Diabetic ketoacidosis (DKA) occurs in 10 to 70% of children with type 1 diabetes mellitus (DM1) and has a significant risk of mortality, mostly due to cerebral edema. [1] Other potential complications of DKA include hypokalemia, hypophosphatemia, hypoglycemia, intracerebral and peripheral venous thrombosis, mucormycosis, rhabdomyolysis, acute pancreatitis, acute renal failure (ARF) and sepsis. The development of ARF with rhabdomyolysis is a rare but potentially lethal diso Continue reading >>

Study: Kidney Injury Risk In Type 1 Children With Dka Is High

Study: Kidney Injury Risk In Type 1 Children With Dka Is High

A recent study found that in children with type 1 diabetes who were hospitalized for diabetic ketoacidosis (DKA), the risk of suffering an acute kidney injury is high. Based on these findings, researchers suggest in their study abstract that clinicians should be aware of these findings and “consider acute kidney injury as a frequent complication in this population.” In order to find out how many children hospitalized with DKA develop an acute kidney injury and to find out what the associated clinical and biochemical markers of an acute kidney injury are, researchers conducted a medical record review of 165 children with type 1 diabetes who were hospitalized with DKA between September 2008 and December 2013. The study took place at British Columbia Children’s Hospital in British Columbia, Canada. Researchers looked at records of children age 18 or younger with type 1 and DKA who had a complete medical record available for data analysis and defined an acute kidney injury using the serum creatinine criteria set by the Kidney Disease/Improving Global Outcomes (KDIGO). KDIGO, according to their website is a, “global organization developing and implementing evidence based clinical practice guidelines in kidney disease. It is an independent volunteer-led self-managed charity incorporated in Belgium accountable to the public and the patients it serves.” How Many Children Suffer Acute Kidney Injury from DKA? The study found that of the 165 children who were hospitalized with DKA, 106 or 64.2 percent developed an acute kidney injury. Acute kidney injury is measured in stages with stage 1 being the least severe. Of the 106 children who developed an acute kidney injury, 37 or 34.9 percent developed a stage 1 acute kidney injury, 48 or 45.3 percent developed a stage 2 acut Continue reading >>

Acute Kidney Injury As A Severe Complication Of Diabetic Ketoacidosis

Acute Kidney Injury As A Severe Complication Of Diabetic Ketoacidosis

Endocrine Abstracts (2015) 39 EP55 | DOI: 10.1530/endoabs.39.EP55 Acute kidney injury as a severe complication of diabetic ketoacidosis Alagusutha Jeyaraman1, Verghese Mathew1, Eric Finlay2 & Sanjay Gupta1 Author affiliations View ePoster Download ePoster 1Hull Royal Infirmary, Hull, UK; 2General Infirmary, Leeds, UK. Background: Diabetic ketoacidosis (DKA) in children and young adults carries significant morbidity and mortality relating to complications such as cerebral oedema. Acute kidney injury (AKI) is a rare but potentially fatal complication of DKA. We present three cases of DKA complicated by AKI. Case 1: A 9-year-old girl presented with severe DKA at diagnosis. She was treated with intravenous fluids and insulin as per protocol. She had oliguria and haematuria 36 h after admission. She was hypertensive with evidence of enlarged kidneys on ultrasound (USS). She was transferred to the renal unit where she needed two cycles of hemodialysis before making full recovery. Case 2: A 14-year-old girl presented with severe DKA and altered consciousness at diagnosis. She developed oliguria 24 h after starting treatment for DKA. USS of abdomen showed enlarged kidneys. Her renal function improved with haemofiltration and recovered fully by 1 week. Case 3: 17-year-old girl with poorly controlled type 1 diabetes presented with severe DKA. She showed evidence of AKI with very high plasma creatinine, oliguria and low plasma phosphate. She was managed conservatively with individualised fluid plan and phosphate supplementation with recovery in 7 days. Conclusion: Patients with severe DKA can develop AKI due to a number of possible causes, hypovolaemia being the most likely primary cause. Appropriate management of hypovolemia and electrolyte disturbance in these patients can be v Continue reading >>

Aki Seen In 64% Of Children Hospitalized With Diabetic Ketoacidosis

Aki Seen In 64% Of Children Hospitalized With Diabetic Ketoacidosis

A high proportion of children with type 1 diabetes who are hospitalized for diabetic ketoacidosis (DKA) develop acute kidney injury (AKI), according to results from a study. Researchers reviewing records from a Canadian hospital found that in a cohort of 165 children hospitalized for DKA during a 5-year period (2008-2013), 64% developed the complication. Severe forms of AKI (stage 2 or 3) were common, representing 45% and 20%, respectively, of children with AKI. Two patients in the cohort required dialysis. In their research published online March 13 in JAMA Pediatrics, Brenden E. Hursh, MD, and his colleagues at the University of British Columbia and the British Columbia Children’s Hospital, both in Vancouver, noted that AKI rates among hospitalized children had not been systematically studied before. “We hypothesized that, because DKA is associated with both volume depletion and conservative fluid administration upon presentation, these children are potentially at high risk for AKI, above the level of risk expected by the rare reported cases in the literature,” Dr. Hursh and his colleagues wrote (JAMA Pediatr. 2017 Mar 13. doi: 10.1001/jamapediatrics.2017.0020). The investigators found that lower serum bicarbonate levels and elevated heart rates were indeed associated with increased risk of severe AKI. Serum bicarbonate level of less than 10 mEq/L was associated with a fivefold increase in the odds of severe (stage 2 or 3) AKI (adjusted odds ratio, 5.22; 95% confidence interval, 1.35-20.22). Each increase of 5 bpm in initial heart rate was associated with a 22% increase in the odds of severe AKI (aOR, 1.22; 95% CI, 1.07-1.39). Dr. Hursh and his colleagues defined AKI using serum creatinine values. As baseline values prior to hospital admission were not available Continue reading >>

Children With Diabetic Ketoacidosis At High Risk Of Aki

Children With Diabetic Ketoacidosis At High Risk Of Aki

Children With Diabetic Ketoacidosis at High Risk of AKI Children With Diabetic Ketoacidosis at High Risk of AKI A 22% increase in odds of developing AKI was seen for each initial heart rate increase of 5 beats per minute. Among children with type 1 diabetes, new data published in JAMA Pediatrics demonstrate that a high proportion of those who are hospitalized for diabetic ketoacidosis (DKA) develop acute kidney injury (AKI). The researchers of the study aimed to establish the proportion of children hospitalized for DKA who develop AKI, and to ascertain the clinical and biochemical markers associated with AKI. Overall, the medial record review included all DKA admissions from September 1, 2008, through December 31, 2013, that were conducted at the British Columbia Children's Hospital in British Columbia, Canada. The researchers included 165 children (age, 18 years; median age, 10.6 years; 53.9% female) with type 1 diabetes and DKA and with complete medical records available for analysis. The primary outcome was AKI, defined via the Kidney Disease/Improving Global Outcomes serum creatinine criteria. The researchers used multinomial logistic regression to determine potential factors associated with AKI. Results indicated that 64.2% of children developed AKI , of whom 34.9% had stage 1, 45.3% had stage 2, and 19.8% had stage 3, and 2 children required hemodialysis . According to the adjusted multinomial logistic regression model, a serum bicarbonate level <10 mEq/L compared with 10 mEq/L yielded a more than 5-fold increase in the likelihood of severe (stage 2 or 3) AKI (adjusted odds ratio [aOR], 5.22; 95% CI, 1.35-20.22). For each initial heart rate increase of 5 beats per minute, the researchers observed a 22% increase in the odds for severe AKI (aOR, 1.22; 95% CI, 1.07- Continue reading >>

Diabetic Ketoacidosis Associated With Acute Kidney Injury

Diabetic Ketoacidosis Associated With Acute Kidney Injury

A new Journal of American Medical Association article has shown that there is a high rate of occurrence of acute kidney injury (AKI) in children hospitalized with a diagnosis diabetic ketoacidosis (DKA). Acute kidney injury is one of the most common causes of renal injury that can arise from several aetiologies. Based on predisposing factors, the causes may be categorized into 3 classes: pre-renal, renal or post-renal. In cases of volume depletion, like that which occurs in diabetic ketoacidosis (a complication of diabetes where there is high ketone production), perfusion to kidneys is impaired and that is when the kidneys start to lose their functioning. Since acute kidney injury in children is associated with a poor short term and long term outcome, in a new JAMA article, and for the first time, researchers have evaluated the rate of acute kidney injury (AKI) in pediatric patients who were hospitalized for the diabetic ketoacidosis. This study was conducted at the British Columbia Children’s Hospital from 2008 through 2013. 165 children aged 18 years or younger with type 1 diabetes, DKA and with complete medical records available for data analysis were included. The primary outcome was the development of acute kidney injury defined using Kidney Disease/Improving Global Outcomes serum creatinine criteria. As per findings, in the designed timeframe, of the 165 children hospitalized for DKA, 106 (64.2%) developed AKI.Two children required hemodialysis. Statistical analysis has shown that a serum bicarbonate level of less than 10 mEq/L was associated with a 5-fold increased risk of developing severe kidney injury. This means that the incidence of acute kidney injury is directly associated with the severity of the acidosis resulting from DKA. Increase in heart rate (demo Continue reading >>

Acute Kidney Injury Frequent In Kids With Diabetic Ketoacidosis

Acute Kidney Injury Frequent In Kids With Diabetic Ketoacidosis

Acute Kidney Injury Frequent in Kids With Diabetic Ketoacidosis Of children with type 1 diabetes who were hospitalized for diabetic ketoacidosis (DKA), 64% developed acute kidney injury (AKI), according to a new study published online March 13 2017 in JAMA Pediatrics. The work is the first to show that acute kidney injury is a frequent complication of pediatric DKA. The latter can be life-threatening and represents the leading cause of hospitalization in youth with type 1 diabetes. This high percentage is concerning because acute kidney injury is associated with increased morbidity and mortality. Studies have also suggested that it may increase the risk of later chronic kidney disease, a condition for which youngsters with type 1 diabetes are already at increased risk. Results also showed that patients with severe acidosis and profound volume depletion were at increased risk of severe acute kidney injury. In DKA, high blood glucose levels can lead to increased urination and volume depletion. Patients also have acidosis and increased production of ketoacids. "On presentation to the hospital, many children with DKA present quite volume depleted, but fluid management" must by necessity be a fine balancing act "because of the risk for cerebral edema," which represents the most serious complication of DKA and can lead to death, senior author Dina Panagiotopoulos, MD, of the University of British Columbia, Vancouver) told Medscape Medical News via email. Acidosis, Tachycardia, Hypernatremia Associated With AKI For the study, the Canadian doctors reviewed the medical records of 165 youth aged 18 years and younger with type 1 diabetes admitted for DKA to British Columbia Children's Hospital in Vancouver between September 2008 and December 2013. They defined acute kidney injury Continue reading >>

More in diabetes