Key result
Pediatric DKA linked to ECG changes in ~58% of patients, associated with elevated blood sugar.
Why the study?
Cardiac arrhythmias and arrest in children with diabetic ketoacidosis are presumed to be caused by electrolyte abnormalities, but the role of ECG monitoring in diagnosis is unclear.
Cross-Sectional (n=100)
No
Electrocardiographic changes, particularly prolonged QTc and QT dispersion, are highly prevalent in children presenting with diabetic ketoacidosis and correlate significantly with severe hyperglycemia.
Answers are grounded in this paper and cite their sources.
ECG changes may signal arrhythmia risk in pediatric DKA; hypothesis-generating and should not yet change practice.
Introduction: Cardiac arrhythmias and arrest have been described in children with diabetic ketoacidosis and generally have been presumed to be caused by electrolyte abnormalities. The rationale of this study was to assess the role and importance of ECG monitoring, as a simple, quick, non-invasive and readily available tool in the diagnosis and confirmation of hypokalemia and hyperkalemia in patients with DKA in the Emergency Department Objective: To Assess the Frequency of electrocardiographic changes in Type-1 diabetes mellitus children with diabetic ketoacidosis presenting to tertiary care hospital, Karachi. Materials and Methods: This retrospective cross sectional study was carried out at the department of pediatric medicine, NICH Karachi. At the time of presentation, the standard 12-lead ECG was recorded by a single pediatric cardiologist having more than 2 years of experience, QT and RR intervals were measured. Three separate measurements were obtained from each ECG, and the mean of these measurements was used as the value for QTC. QTC of at least 0.45s (450ms) was considered as prolonged QTC. QTD was also assessed at the same time and QTD>50 ms was considered as prolonged QTD. Results: One hundred cases of T1DM with DKA were included in this study. Average age of children was 7.9 ±3.5 years (Min – Max = 0.5 – 14 years), male to female ratio was 1: 0.96. Prolong QTc and QTd interval was observed in (56%) and (38%) children respectively, Mean (±SD) QTc and QTd interval was 449.4 ±36.6 mc and 39.3 ±16.1 mc respectively. While ECG changes were found in (58%) cases. Association between ECG changes and the cases with higher RBS (>350 mg/dl) was statistically significant 81 (81%) cases with ECG changes had higher RBS (p<0.0001) while ECG changes were statistically similar in both age groups and gender (p-values > 0.05). Conclusion: The frequency of ECG changes was higher in T1DM children with diabetic ketoacidosis. ECG changes was significantly associated with higher RBS (>350 mg/dl).
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Rafique et al. (2021) conducted a cross-sectional in Type-1 Diabetes Mellitus with Diabetic Ketoacidosis (n=100). Diabetic Ketoacidosis was evaluated on Frequency of electrocardiographic changes. Electrocardiographic changes were present in 58% of children with Type-1 diabetes mellitus and diabetic ketoacidosis, with a significant association observed in those with random blood sugar >/dl.
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