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pediatric diabetic ketoacidosis

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https://www.readbyqxmd.com/read/28321786/adherence-to-pediatric-diabetic-ketoacidosis-guidelines-by-community-emergency-departments-providers
#1
Janine E Zee-Cheng, Emily C Webber, Samer Abu-Sultaneh
BACKGROUND: Diabetic ketoacidosis (DKA) is a common presentation of type I diabetes mellitus to the emergency departments. Most children with DKA are initially managed in community emergency departments where providers may not have easy access to educational resources or pediatric-specific guidelines and protocols that are readily available at pediatric academic medical centers. The aim of this study is to evaluate adherence of community emergency departments in the state of Indiana to the pediatric DKA guidelines...
December 2017: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28288246/acute-kidney-injury-in-children-with-type-1-diabetes-hospitalized-for-diabetic-ketoacidosis
#2
Brenden E Hursh, Rebecca Ronsley, Nazrul Islam, Cherry Mammen, Constadina Panagiotopoulos
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...
March 13, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28203360/blood-versus-urine-ketone-monitoring-in-a-pediatric-cohort-of-patients-with-type-1-diabetes-a-crossover-study
#3
Line Goffinet, Thierry Barrea, Véronique Beauloye, Philippe A Lysy
BACKGROUND: The aim of our study was to determine the influence of routine ketone monitoring on hyperglycemic events (HE) and ketosis in youngsters with type 1 diabetes (T1D). METHODS: Our single-site, controlled and randomized study was conducted on children and adolescents with T1D outside of remission phase. During two crossover periods of 6 months, patients (n = 22) experiencing HE tested ketones alternatively with a blood ketone meter or urine ketone test strips and gave their opinion on screening methods after completion of clinical trial...
January 2017: Therapeutic Advances in Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28146595/pediatric-diabetes-outpatient-center-at-rhode-island-hospital-the-impact-of-changing-initial-diabetes-education-from-inpatient-to-outpatient
#4
Mia M Pingul, Erin M Mulvihill, Steven E Reinert, Geetha Gopalakrishnan, Wendy A Plante, Charlotte M Boney, Shara R Bialo, Jose Bernardo Quintos
BACKGROUND: This study compared outcomes and costs for new-onset Type 1 diabetes mellitus (T1DM) patients educated at the outpatient versus inpatient settings. METHODS/DESIGN: Retrospective study examining the following variables: 1) hemoglobin A1c (HbA1c), 2) severe hypoglycemia, 3) admissions for diabetic ketoacidosis (DKA) or ER visits, and 4) healthcare cost. RESULTS: 152 patients with new-onset T1DM from September 2007-August 2009. There were no differences between outpatient group (OG) and inpatient group (IG) in mean HbA1c levels at 1, 2 and 3 years post-diagnosis (OG 8%, 8...
February 1, 2017: Rhode Island Medical Journal
https://www.readbyqxmd.com/read/28135278/clinical-characteristics-of-diabetic-ketoacidosis-in-children-with-newly-diagnosed-type-1-diabetes-in-addis-ababa-ethiopia-a-cross-sectional-study
#5
Helen Siyoum Atkilt, Muluken Gizaw Turago, Balewgizie Sileshi Tegegne
BACKGROUND: Diabetic ketoacidosis (DKA) is one of the most serious acute complications of type 1 diabetes (T1D) and the leading cause of morbidity and mortality in children with T1D. This study was aimed at assessing the prevalence and associated factors of DKA in children with newly diagnosed T1D in Addis Ababa. METHODS: A hospital based cross-sectional study was conducted in selected hospitals in Addis Ababa. Children below the age of 12 years with DKA who were admitted to the pediatric ward in the selected hospitals between January 2009 and December 2014 and the residence of Addis Ababa were included...
2017: PloS One
https://www.readbyqxmd.com/read/28130944/pediatric-insulin-pump-therapy-reflecting-on-the-first-10-years-of-a-universal-funding-program-in-ontario
#6
Rayzel Shulman, Fiona A Miller, Thérèse A Stukel, Denis Daneman, Astrid Guttmann
We evaluated the universal funding program for pediatric insulin pumps in Ontario by examining the dynamics underlying patterns of pump use and adverse events using population-based health administrative data available at the Institute for Clinical Evaluative Sciences (ICES), supplemented by other data. We found that (1) pump use has increased steadily since 2006 with variation across centres and disparity in use by socioeconomic status; (2) pump discontinuation is uncommon; (3) physicians value pump therapy in numerous ways that provide important insights into patterns of uptake; and (4) the safety profile of pump therapy is, in general, very good; however, individuals of lower socioeconomic status are at an increased risk of acute diabetes complications, most frequently diabetic ketoacidosis...
2017: Healthcare Quarterly
https://www.readbyqxmd.com/read/28107262/suspected-cerebral-edema-in-diabetic-ketoacidosis-is-there-still-a-role-for-head-ct-in-treatment-decisions
#7
Carmen L Soto-Rivera, Lisa A Asaro, Michael S D Agus, Danielle D DeCourcey
OBJECTIVES: Neurologic deterioration associated with cerebral edema in diabetic ketoacidosis is typically sudden in onset, progresses rapidly, and requires emergent treatment. The utility of brain imaging by head CT in decisions to treat for cerebral edema has not been previously studied. The objective of this study was to describe the characteristics of pediatric patients with diabetic ketoacidosis who develop altered mental status and evaluate the role of head CT in this cohort. DESIGN: Retrospective analysis of clinical, biochemical, and radiologic data...
March 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28043933/clinical-biochemical-and-histopathology-features-of-patients-with-glycogenic-hepatopathy
#8
Saurabh Mukewar, Ayush Sharma, Kandace Lackore, Felicity Enders, Michael Torbenson, Patrick S Kamath, Lewis R Roberts, Yogish C Kudva
BACKGROUND & AIMS: Glycogenic hepatopathy, a syndrome characterized by hepatomegaly and increased liver transaminases in patients with type 1 diabetes, has not been well characterized in adults. We describe the clinical, biochemical, and histopathology profile of a cohort of patients with glycogenic hepatopathy. We also examined differences between patients with type 1 diabetes with versus without glycogenic hepatopathy. METHODS: We performed a case-control study of patients with type 1 diabetes diagnosed with glycogenic hepatopathy and patients with type 1 diabetes without glycogenic hepatopathy (control subjects)...
December 30, 2016: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28018153/a-pediatric-diabetic-ketoacidosis-management-protocol-incorporating-a-two-bag-intravenous-fluid-system-decreases-duration-of-intravenous-insulin-therapy
#9
Megan Veverka, Kourtney Marsh, Susan Norman, Michael Alan Brock, Monica Peng, Jennifer Shenk, Jerome Gene Chen
OBJECTIVES: Diabetic ketoacidosis (DKA) is a leading cause of morbidity and mortality in children with type 1 diabetes. We implemented a standardized DKA management protocol by using a 2-bag intravenous (IV) fluid system. The purpose of the study was to examine if the protocol improved clinical outcomes and process efficiency. METHODS: This was a retrospective study of patients who did and did not undergo the protocol. Patients were included if they were 18 years of age or younger, were diagnosed with DKA, admitted to an intensive care unit or stepdown unit, and received continuous IV insulin...
November 2016: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/28013254/stroke-in-pediatric-diabetic-ketoacidosis-case-series
#10
Chandrika Azad, Ravinder Kaur, Dharmendra Kumar Singh, Adhi Arya
Diabetic ketoacidosis (DKA) can present with various neurological complications, but stroke is rare. Here, we present three children with recent-onset diabetes with DKA, two of them had deep coma not responding to standard DKA regimen and the third one had seventh nerve palsy noted after recovering from coma. Computed tomography scan of head showed hemorrhage in the area of midbrain in one patient and infarcts in two patients. In any child of DKA with severe neurological impairment, possibility of stroke should be entertained...
December 24, 2016: Journal of Tropical Pediatrics
https://www.readbyqxmd.com/read/28004468/first-2-cases-with-thiamine-responsive-megaloblastic-anemia-in-the-czech-republic-a-rare-form-of-monogenic-diabetes-mellitus-a-novel-mutation-in-the-thiamine-transporter-slc19a2-gene-intron-1-mutation-c-204-2t-g
#11
Renata Pomahačová, Jana Zamboryová, Josef Sýkora, Petra Paterová, Karel Fiklík, Tomáš Votava, Zdeňka Černá, Petr Jehlička, Václav Lád, Ivan Šubrt, Jiří Dort, Eva Dortová
Thiamine-responsive megaloblastic anemia (TRMA) is a rare autosomal recessive disorder caused by mutations in the SLC19A2 gene. To date at least 43 mutations have been reported for the gene encoding a plasma membrane thiamine transporter protein (THTR-1). TRMA has been reported in less than 80 cases worldwide. Here, we illustrate 2 female patients with TRMA first diagnosed in the Czech Republic and in central Europe being confirmed by sequencing of the THTR-1 gene SLC19A2. Both subjects are compound heterozygotes with 3 different mutations in the SLC19A2 gene...
December 22, 2016: Pediatric Diabetes
https://www.readbyqxmd.com/read/27991500/high-frequency-of-diabetic-ketoacidosis-at-diagnosis-of-type-1-diabetes-in-italian-children-a-nationwide-longitudinal-study-2004-2013
#12
Valentino Cherubini, Edlira Skrami, Lucia Ferrito, Stefano Zucchini, Andrea Scaramuzza, Riccardo Bonfanti, Pietro Buono, Francesca Cardella, Vittoria Cauvin, Giovanni Chiari, Giuseppe D Annunzio, Anna Paola Frongia, Dario Iafusco, Ippolita Patrizia Patera, Sonia Toni, Stefano Tumini, Ivana Rabbone, Fortunato Lombardo, Flavia Carle, Rosaria Gesuita
This longitudinal population-based study analyses the frequency of diabetic ketoacidosis (DKA) at type 1 diabetes diagnosis in Italian children under 15 years of age, during 2004-2013. DKA was defined as absent (pH ≥ 7.30), mild/moderate (7.1 ≤ pH < 7.30) and severe (pH < 7.1). Two multiple logistic regression models were used to evaluate the time trend of DKA frequency considered as present versus absent and severe versus absent, adjusted for gender, age group and geographical area of residence at diagnosis...
December 19, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27939878/components-of-interventions-that-improve-transitions-to-adult-care-for-adolescents-with-type-1-diabetes
#13
REVIEW
Alan T Schultz, Arlene Smaldone
Adolescents with type 1 diabetes struggle with glycemic control with decline further exacerbated by transfer from pediatric to adult care. The purpose of this systematic review/meta-analysis was to examine which components of transition programs are effective in improving outcomes following transfer. We searched six databases for studies that assessed the efficacy of a transition program on diabetes outcomes. Studies reporting hemoglobin A1c (HbA1c) or its change for the intervention versus control group pretransition and posttransition were pooled using a random effects meta-analysis model...
February 2017: Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine
https://www.readbyqxmd.com/read/27896145/interprofessional-multiple-step-simulation-course-improves-pediatric-resident-and-nursing-staff-management-of-pediatric-patients-with-diabetic-ketoacidosis
#14
Linnea M Larson-Williams, Amber Q Youngblood, Dawn Taylor Peterson, J Lynn Zinkan, Marjorie L White, Hussein Abdul-Latif, Leen Matalka, Stephen N Epps, Nancy M Tofil
AIM: To investigate the use of a multidisciplinary, longitudinal simulation to educate pediatric residents and nurses on management of pediatric diabetic ketoacidosis. METHODS: A multidisciplinary, multiple step simulation course was developed by faculty and staff using a modified Delphi method from the Pediatric Simulation Center and pediatric endocrinology department. Effectiveness of the simulation for the residents was measured with a pre- and post-test and a reference group not exposed to simulation...
November 4, 2016: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27822115/danish-registry-of-childhood-and-adolescent-diabetes
#15
REVIEW
Jannet Svensson, Charlotte Cerqueira, Per Kjærsgaard, Lene Lyngsøe, Niels Thomas Hertel, Mette Madsen, Henrik B Mortensen, Jesper Johannesen
AIM: The aims of the Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids) are to monitor and improve the quality of care for children and adolescents with diabetes in Denmark and to follow the incidence and prevalence of diabetes. STUDY POPULATION: The study population consists of all children diagnosed with diabetes before the age of 15 years since 1996. Since 2015, every child followed up at a pediatric center (<18 years of age) will be included...
2016: Clinical Epidemiology
https://www.readbyqxmd.com/read/27807910/glargine-co-administration-with-intravenous-insulin-in-pediatric-diabetic-ketoacidosis-is-safe-and-facilitates-transition-to-a-subcutaneous-regimen
#16
V Sanoe Harrison, Stacy Rustico, Andrew A Palladino, Christine Ferrara, Colin Patrick Hawkes
BACKGROUND: Diabetes ketoacidosis (DKA) is a common presentation and complication of type 1 diabetes (T1D). While intravenous insulin is typically used to treat acute metabolic abnormalities, the transition from intravenous to subcutaneous treatment can present a challenge. We hypothesize that co-administration of glargine, a subcutaneous long-acting insulin analog, during insulin infusion may facilitate a flexible and safe transition from intravenous to subcutaneous therapy. OBJECTIVE: To determine if the practice of administering subcutaneous glargine during intravenous insulin is associated with an increased risk of hypoglycemia, hypokalemia, or other complications in children with DKA...
November 3, 2016: Pediatric Diabetes
https://www.readbyqxmd.com/read/27770618/diabetic-ketoacidosis-in-a-pediatric-intensive-care-unit
#17
Clarice L S Lopes, Paula Pitta Pinheiro, Luzia S Barberena, Guilherme U Eckert
OBJECTIVE: To describe the characteristics of children aged 0-14 years diagnosed with diabetic ketoacidosis and compare the following outcomes between children with prior diagnosis of type 1 diabetes mellitus and children without prior diagnosis of type 1 diabetes mellitus length of hospital stay, severity on admission, insulin dosage, time of continuous insulin use, volume of fluids infused during treatment, and complications. METHODS: A retrospective descriptive study with review of medical records of patients admitted to the pediatric intensive care unit of a referral hospital from June 2013 to July 2015...
October 19, 2016: Jornal de Pediatria
https://www.readbyqxmd.com/read/27758023/clinical-outcomes-in-youth-beyond-the-first-year-of-type-1-diabetes-results-of-the-pediatric-diabetes-consortium-pdc-type-1-diabetes-new-onset-neon-study
#18
Eda Cengiz, Peiyao Cheng, Katrina J Ruedy, Craig Kollman, William V Tamborlane, Georgeanna J Klingensmith, Robin L Gal, Janet Silverstein, Joyce Lee, Maria J Redondo, Roy W Beck
OBJECTIVE: Current data are limited on the course of type 1 diabetes (T1D) in children and adolescents through the first few years of diabetes. The Pediatric Diabetes Consortium T1D new onset (NeOn) Study was undertaken to prospectively assess natural history and clinical outcomes in children treated at 7 US diabetes centers from the time of diagnosis. This paper describes clinical outcomes in the T1D NeOn cohort during the first 3 years postdiagnosis. RESULTS: A total of 1048 participants (mean age 9...
October 19, 2016: Pediatric Diabetes
https://www.readbyqxmd.com/read/27749721/pediatric-type-1-diabetes-reducing-admission-rates-for-diabetes-ketoacidosis
#19
Jeniece Trast Ilkowitz, Steven Choi, Michael L Rinke, Kathy Vandervoot, Rubina A Heptulla
BACKGROUND: Diabetes ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM). Reducing DKA admissions in children with T1DM requires a coordinated, comprehensive management plan. We aimed to decrease DKA admissions, 30-day readmissions, and length of stay (LOS) for DKA admissions. METHODS: A multipronged intervention was designed in 2011 to reach all patients: (1) increase insulin pump use and basal-bolus regimen versus sliding scales, (2) transform educational program, (3) increased access to medical providers, and (4) support for patients and families...
October 2016: Quality Management in Health Care
https://www.readbyqxmd.com/read/27726271/pathways-to-reduce-diabetic-ketoacidosis-with-new-onset-type-1-diabetes-evidence-from-a-regional-pediatric-diabetes-center-auckland-new-zealand-2010-to-2014
#20
Eleanor R Gunn, Benjamin B Albert, Paul L Hofman, Wayne S Cutfield, Alistair J Gunn, Craig A Jefferies
BACKGROUND: There has been little change in the incidence of diabetic ketoacidosis (DKA) in newly diagnosed type 1 diabetes mellitus (T1DM) in children and adolescents in most developed countries. OBJECTIVES: To assess potentially modifiable antecedents of DKA in children <15 years of age with new onset T1DM. METHODS: Retrospective review of prospectively collected data from a complete regional cohort of children with T1DM in Auckland (New Zealand) from 2010 to 2014...
October 11, 2016: Pediatric Diabetes
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