Ketoacidosis at onset of type 1 diabetes mellitus in children – frequency and clinical presentation

  1. Andreas Neu,
  2. Andre Willasch,
  3. Stefan Ehehalt,
  4. Regine Hub,
  5. Michael B. Ranke,
  6. the DIARY group Baden- Wuerttemberg†

Article first published online: 16 JUN 2003

DOI: 10.1034/j.1399-5448.2003.00007.x

Issue

Pediatric Diabetes

Pediatric Diabetes

Volume 4, Issue 2, pages 77–81, June 2003

Additional Information

How to Cite

Neu, A., Willasch, A., Ehehalt, S., Hub, R., Ranke, M. B. and the DIARY group Baden- Wuerttemberg (2003), Ketoacidosis at onset of type 1 diabetes mellitus in children – frequency and clinical presentation. Pediatric Diabetes, 4: 77–81. doi: 10.1034/j.1399-5448.2003.00007.x

Author Information

  1. University of Tuebingen, University Children's Hospital, Tuebingen, Germany

  1. †

    Members of the DIARY group Baden-Wuerttemberg are as follows: Sandra A. Becker (Bad Mergentheim), Volker Berg (Schwäbisch Gmünd), Renate Dürr (Waiblingen), Regine Eberle-Kuntz (Heilbronn), Waldemar K. Ertelt (Heidenheim), Uta Faller (Ravensburg), Lutz Feldhahn (Böblingen), Jürgen Grulich-Henn (Heidelberg), Heinrich Haug (Ludwigsburg), Wolfang Hecker (Stuttgart), Angelika Henzler-Le Boulanger (Lörrach), Ulrich Hermann (Reutlingen), Mathias Herrmann (Singen), Bernhard Höhmann (Aalen), Margarete Kloc (Konstanz), Ursula Krauß (Esslingen), Monika Metzel (Schwäbisch Hall), Beate Meyburg (Mannheim), Martine Pizard-Weyrich (Baden-Baden), Kerstin Placzek (Friedrichshafen), Dimitrij Poletaew (Karlsruhe), Reinhart Sauter (Freiburg), Rüdiger Schnarz (Pforzheim), Hans-Jürgen Schreckling (Bad Mergentheim), Horst Schulmayer (Filderstadt), Andrea Schumacher (Göppingen), K. Otfried Schwab (Freiburg), Martin Wabitsch (Ulm), Matthis M. Walka (Freudenstadt), Christof Wettach (Offenburg), Joachim Wissert (Villingen-Schwenningen).

*Corresponding author: Dr Andreas Neu, University of Tuebingen, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany. Tel. +49-7071-2983781; fax: +49-7071-295475; e-mail: andreas.neu@med. uni-tuebingen.de

Publication History

  1. Issue published online: 16 JUN 2003
  2. Article first published online: 16 JUN 2003
  3. Submitted 11 February 2003. Accepted for publication 17 April 2003

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Keywords:

  • children;
  • diabetes mellitus;
  • incidence registry;
  • ketoacidosis;
  • subtype

Abstract: Background:  Since 1987, patients with newly diagnosed diabetes mellitus type 1 under 15 yr of age have been registered in Baden-Wuerttemberg (BW), Germany.

Aim:  Our aim was to describe the frequency and the clinical presentation of diabetic ketoacidosis (DKA) at onset of type 1 diabetes mellitus in children.

Methods: All 31 pediatric departments in BW and one diabetes center participated in this study. Hospital records of 2121 children below 15 yr of age were examined retrospectively. DKA was defined as glucose > 250 mg/dL, pH < 7.30 or bicarbonate < 15 mmol/L and ketonuria. Statistical analysis was done after logarithmic transformation.

Results: 26.3% (n = 558) of all patients presented with DKA. The mean age of these patients was 7.9 yr. The frequency of DKA is higher in girls than in boys (28.9 vs. 23.8%; p = 0.0079). Those aged 0–4 yr suffered most frequently (p < 0.0001) from ketoacidosis (36.0%). The percentage of DKA in newly diagnosed cases was constant over 10 yr. 23.3% of all patients with DKA presented with an altered level of consciousness; 10.9% of these had clinical signs of coma. No deaths occurred. The proportion of ketoacidosis does not increase concurrently with the number of diabetes manifestations in winter.

Conclusion:  The proportion of DKA in children with newly diagnosed diabetes mellitus is significant. In particular, children < 5 yr and girls face an increased risk. DKA may be the result of a particularly aggressive subtype of diabetes.

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