Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2016) 45 P15 | DOI: 10.1530/endoabs.45.P15

BSPED2016 Poster Presentations Diabetes (32 abstracts)

Severe acute renal failure requiring dialysis in children with diabetic ketoacidosis

Evagelia Paraskevopoulou 1 , Amanda Peacock 2 , Leena Patel 3 , Christine Burren 3 , James Yong 2 , Murray Bain 1 & Christina Wei 1


1St George’s Hospital, London, UK; 2Leeds Children’s Hospital, Leeds, UK; 3Bristol Royal Hospital for Children, Bristol, UK.


Introduction: Acute renal failure (ARF) is a rare but life-threatening complication of severe diabetic ketoacidosis (DKA) in children.

Aim: To characterise the presentation, treatment and clinical course of children with DKA complicated by severe ARF requiring renal support.

Method: Retrospective notes review of patients aged <16 years admitted in 2011–2016 to 3 UK regional paediatric intensive care units (St George’s Hospital, London, Leeds Children’s Hospital and Bristol Royal Hospital for Children) with DKA complicated by ARF requiring renal dialysis.

Results: [Median (range)]. Five (male=2, female=3) cases with type 1 diabetes aged 13.5(9.6–15.9) years were identified, including 4 newly diagnosed and 1 known patient with poor compliance. All presented in winter between December and April. Length of PICU stay was 8(2–20) days. Four were ventilated for 3.5(3–11) days, and 3 required inotropic support. At presentation, HbA1C was 148(90–173) mmol/mol and glucose 35(28–47) mmol/l. Blood gas analysis showed an initial pH of <6.8 in all patients, base excess between unrecordable and −28, bicarbonate between unrecordable and 4.6 mmol/l; and took 2(2–3) days to normalise. Level of dehydration was estimated at 8(7–10)%. All required additional fluid boluses on clinical judgement and, received intravenous fluids and insulin 0.05–0.1 U/kg according to national DKA protocol. Intravenous antibiotics were given to all (positive blood cultures (n=0), positive respiratory secretions with staphylococcus aureus (n=2) and streptococcus pneumoniae (n=1)). None had a previous history of renal impairment. Abnormal renal function was evident from admission with presenting urea 16.9(9.2–29) mmol/l, creatinine 144(82–289) umol/l; and peak urea 21.3(17.4–51.3) mmol/l, creatinine 375(279–903) umol/l. All underwent haemodialysis for 8(1–13) days and renal function normalised after 2 months (9 days–14 months). Renal imaging during initial presentation reported increased echogenicity in 2 and bilateral mild hydronephrosis in 1 patient(s). Hypertension was reported in 2 patients who were both treated by amlodipine that was later discontinued when blood pressure normalised.

Conclusions: Severe ARF in DKA was associated with extremely low blood pH<6.8 and evidence of hypovolaemic shock at presentation. Haemodialysis was effective and all made a full recovery of renal function. However, future risk of chronic renal impairment remains unclear and long term renal surveillance is required.

Volume 45

44th Meeting of the British Society for Paediatric Endocrinology and Diabetes

British Society for Paediatric Endocrinology and Diabetes 

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