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Am J Emerg Med. 2019 Oct 24. pii: S0735-6757(19)30598-4. doi: 10.1016/j.ajem.2019.158449. [Epub ahead of print]

Is lactic acidosis predictive of outcomes in pediatric diabetic ketoacidosis?

Author information

1
Division of Emergency Medicine, Department of Pediatrics, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA. Electronic address: Matthew.Cully@nemours.org.
2
Division of Emergency Medicine, Department of Pediatrics, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA.

Abstract

OBJECTIVES:

The objective of this study was to investigate the significance and prevalence of lactic acidosis in pediatric diabetic ketoacidosis (DKA) presenting to the emergency department.

METHODS:

A retrospective cohort study of children (age ≤ 21 years) presenting to a tertiary care emergency department in DKA from December 1, 2015 to December 1, 2018. Patients needed to have DKA requiring admission to the pediatric intensive care unit and have had a lactate level collected while in the emergency department to be included.

RESULTS:

92 patients resulting in 113 encounters had DKA and a lactate level collected in the emergency department. The mean lactate level was 3.5 mmol/L (±SD 2.1). 72 (63.7%) encounters had lactic acidosis (p < 0.001). There was no significant association between the presence of lactic acidosis and pediatric intensive care unit length of stay (p = 0.321), hospital length of stay (p = 0.426), morbidity (p = 0.552) and mortality (p = 1.000). Initial glucose levels were significantly higher in the patients presenting with lactic acidosis (p = 0.001).

CONCLUSIONS:

Lactic acidosis is a common finding in pediatric DKA patients presenting to the emergency department. Serum lactate alone should not be used as an outcome predictor in pediatric DKA.

KEYWORDS:

Diabetic ketoacidosis; Hyperglycemia; Lactic acidosis

PMID:
31704063
DOI:
10.1016/j.ajem.2019.158449

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