Clinical and epidemiological analysis of children and adolescents with diabetic ketoacidosis in a referral hospital in the interior of the state of Sao Paulo

Abstract

Introduction: Diabetic ketoacidosis (DKA) is an acute complication that occurs in diabetic patients. Aim: To analyze the clinical and epidemiological profile of children and adolescents admitted with DKA to a referral hospital in the interior of São Paulo. Material and Methods: This cross-sectional study is based on analyzing medical records of pediatric patients referred for evaluation due to hyperglycemia between 2019-2024. DKA was considered in patients who presented with hyperglycemia (≥200mg/dl), ketonemia (≥3mmol/L), and/or moderate ketonuria (≥+2), along with metabolic acidosis (bicarbonate <18mmol/L and/or venous pH <7.3). Results: 49 hospitalizations due to hyperglycemia were evaluated, and 31 (63%) cases of DKA were identified. Most patients were female (59%), in puberty (58%), and classified as having severe DKA (n=18, 58%). The majority of patients was new-onset type 1 diabetes (70%, n=19), and it was associated with infectious conditions (51%, n=16). The most frequently reported symptoms were polyuria (74%) and polydipsia (71%). The mean time between symptom onset and diagnosis was 10 days. There was no statistical correlation between severity and gender, age, pubertal stage, or place of residence (urban/rural). Patients in puberty and living in rural areas had a higher recurrence rate (P=0.039 and P=0.046, respectively). The shortest time to diagnosis and the highest occurrence of complications were associated with infections (P=0.009 and P=0.03). Conclusion: DKA predominantly affected female adolescents, most presenting severe cases and classic symptoms, with higher recurrence risks linked to rural living and infections.