EFFECT OF DIABETIC KETOACIDOSIS ON CHILDREN MYOCARDIAL FUNCTION

Insulin dependent diabetes mellitus is the most common endocrine disorder of childhood and adolescence. Diabetic ketoacidosis (DKA) is the most important and dangerous complication of IDDM. The major causes of mortality and morbidity in diabetic ketoacidosis are abnormalities in metabolic and electrolytes. Studies suggest that metabolic acidosis impairs the contractile function of the heart. The aim of this study was to evaluate of the effect of diabetic ketoacidosis on the myocardial function. This study was a cross sectional- analytical study. Twenty-six children with diabetic ketoacidosis who were admitted to the endocrine ward of Nemazee Hospital were studied. Clinical, laboratory and electrocardiogram findings of these patients were evaluated. To determine the side effect of diabetic ketoacidosis on myocardial function, echocardiography, ejection fraction and fractional shortening of the heart were assessed on admission and 48 hours after recovery. The results of this study showed that ketoacidosis was the initial presentation among 17 out of 26 patients with diabetic ketoacidosis, and most of these patients had severe acidosis. Suggesting that diagnosis and referral of diabetic children to the hospital is made with delay. The echocardiographic results showed that the initial ejection fraction and fractional shortening during ketoacidosis were significantly lower than the final post recovery state (P<0.05). This effect was directly related to severity of acidosis. Our findings support the idea that diabetic ketoacidosis has a detrimental effect on cardiac contractility, and it can be prevented with its severe complications with implementation of an educational program both for diabetic children and their parents, rapid diagnosis and proper management of diabetic ketoacidosis.