To analyze and summarize the clinical characteristics, diagnosis and treatment of children with diabetic ketoacidosis (DKA).

From February 1, 2015 to December 31, 2017, a total of 70 children with DKA who were admitted to Department of Pediatrics, West China Second University Hospital, Sichuan University were selected as research subjects.Among them, 25 cases were boys, and 45 cases were girls. They were aged from 10 months and 11 days to 14 years and 7 months, and 18 cases (25.7%) had a family history of diabetes. Clinical data of all research subjects, such as clinical manifestations, laboratory examination results, treatment and outcomes were collected by retrospective analysis method. The proportion of different clinical manifestations, and proportion of abnormal results of laboratory examination were expressed by rate (%). The procedures followed in this study were in line with the World Medical Association Declaration of Helsinki revised in 2013.

The analysis results of 70 children with DKA were as follows. ①Clinical manifestations: 60 cases (85.7%) showed polydipsia, polyphagia and polyuria, among them, 22 cases (31.4%) with weight loss, 22 cases (31.4%) with symptoms of gastrointestinal tract diseases (vomiting, diarrhea, abdominal pain), 13 cases (18.6%) with poor mental and/or fatigue, 15 cases (21.4%) with disturbance of consciousness (sleepiness or coma), 29 cases (41.4%) with symptoms of respiratory tract diseases (fever, sore throat, cough, oppression in chest, shortness of breath or dyspnea), and 1 case (1.4%) with mass under armpit. And 6 cases (8.6%) showed polydipsia and polyuria, 2 cases (2.9%) showed polydipsia and fatigue, and 2 cases (2.9%) showed polydipsia and weight loss. All children (100.0%) had signs of dehydration such as dry skin and/or decreased skin elasticity, and 16 cases (22.9%) were accompanied with deep breathing and ketone smell (rotten apple flavor) in breath. ②Laboratory examination results: 30 cases (42.9%) had increased white blood cell counts; 30 cases (42.9%) had increased serum C reactive protein (CRP) levels; increased concentrations of venous blood glucose and serum β-hydroxybutyrate were found in all children, which were 13.4-41.6 mmol/L (normal reference range was 3.9-11.1 mmol/L) and ≥3.00 mmol/L (normal reference range was 0.03-0.30 mmol/L), respectively. All children (100.0%) were with positive urine ketone body (2+ to 4+ ), and their venous blood pH values of venous blood were 6.89-7.28. The hemoglobin A1c (HbA1c) level increased in all children, 65 cases (92.9%) with C peptide levels decreased, 6 cases (8.6%) with blood K⁺ concentration decreased, 25 cases (35.7%) with blood Na⁺ concentration decreased, 8 cases (11.4%) had abnormal liver function, 32 cases (45.7%) had abnormal renal function, and 31 cases (44.3%) had abnormal thyroid function. ③Treatments and outcomes: after receiving combined modality therapy, such as fluid replacement, correction of internal environment disorders, infusion of insulin, removal of incentives and anti-infective treatment of antibiotics, prevention and treatment of cerebral edema, blood glucose of all children were controlled well, and serum β-hydroxybutyric acid concentrations all were ≤ 1 mmol/L, venous blood pH values all were >7.30, urine sugar and urine ketone body all were negative, electrolyte disorders were corrected, functions of damaged were recovered, and all children were cured and discharged from hospital.

The clinical manifestations of children with DKA are diversified, its pathogenetic conditions develop rapidly, and multiple organ dysfunction is easy to occur. Early diagnosis and prompt fluid infusion, correction of internal environment disorders, insulin therapy and rational anti-infection are the keys to successful treatment of children with DKA.