Abstract:
Background: Despite typical constitutional findings (polyuria, weight loss, and polydipsia), clinical presentation of diabetic ketoacidosis also includes nausea, frequent vomiting and abdominal pain. Moreover, diffuse abdominal tenderness and diminished or absent peristalsis might mimic acute abdomen in pediatric patients. There is paucity of published data regarding prevalence, dynamics and associated laboratory findings in pediatric patients with abdominal pain in DKA.
Aim: To evaluate prevalence of abdominal pain in pediatric DKA; compare and correlate clinical and laboratory findings between children with and without abdominal pain in DKA.
Materials and methods: Ninety-nine pediatric patients’ records with diagnosis “diabetic ketoacidosis” on admission from January 2016 to December 2021 were screened for this retrospective single center study. Primary inclusion criteria of DKA were met by 58 pediatric patients (pH<7,3; blood sugar≥11mmol/l; urine ketones>++; negative diagnostic abdominal ultrasound). Additionally we included 22 patients transported from the low resource hospital settings (pH was not measured initially) according to the standard patient pathway. These patients had already received initial resuscitation upon admission to our settings and showed improved blood sugar and pH levels. Thus, exclusion criteria of this subgroup included pH>7,35, urine ketones<++, with no regards to blood sugar upon secondary check-up. All patients (age range -3-17 yo) were divided into two groups: control – patients without abdominal pain (n=53), study grouP– patients with abdominal pain (n=27). Initial work-up included HbAc1, pH, electrolytes, CBC etc. The local institutional bioethics committee approved the study design.
Results: Prevalence of abdominal pain was 36% (13/36) and 32% (14/44) in new onset T1DM and previously confirmed diabetes (OR: 1.2112; CI 95% [0.4779 - 3.0699], P=0.6864. Tenderness upon palpation of the LUQ and periumbilical region was elicited among 59% (16/27) and 18.5% (5/27) of patients, respectively. Mean pH upon admission was 7.16±0.15 and 7.19±0.11 among the controls and the study group, respectively (P=0.2901). HbAc1 ranged from 7 to 17,5% (controls – 12.62±2.09%; the study group -12.41±2.4%, P=0,6998). Leukocytosis was found in both groups (controls -16.09±8.81*109/l; the study group -15.85±6.75*109/l, P=0,9013). 71% (5/7) of patients with severe DKA, 31% with moderate (12/39) and 35% (7/20) with mild DKA suffered from abdominal pain. No significant associations between DKA severity and presence of abdominal pain were observed.
Conclusions: One in three pediatric patients experience abdominal pain in DKA. This clinical finding is not associated with severity of DKA, pH level, WBC count and HbAc1 in children with negative diagnostic abdominal ultrasound.
