Clinical Presentation and Outcomes of Diabetic Ketoacidosis in Pediatric Patients: A Retrospective Study at Tripoli University Hospital

Abstract

Diabetic ketoacidosis (DKA) is an acute, potentially life-threatening complication of diabetes mellitus in children. It may be the first clinical manifestation of type 1 diabetes and can be accompanied by substantial fluid, electrolyte, and acid–base disturbances. Local data on pediatric DKA presentations and short-term outcomes can help identify priorities for earlier recognition and safer hospital care. To describe the clinical presentation, biochemical abnormalities, complications, and short-term hospital outcomes of children admitted with DKA to Tripoli University Hospital. This retrospective hospital-based study reviewed the clinical records of children aged 2–15 years admitted with DKA to Tripoli University Hospital during 2025–2026. The 59 DKA episodes were recorded. Demographic and clinical characteristics, DKA severity, laboratory results, treatment-associated electrolyte disturbances, and in-hospital outcomes were extracted from the records. The descriptive analyses and chi-square tests, with statistical significance defined as p<0.05. The 59 DKA episodes had a mean age of 10 years. Females accounted for 74.6% of the sample, and 89.8% of episodes occurred in children newly diagnosed with type 1 diabetes. Vomiting was the most frequently reported symptom (32.2%), followed by abdominal pain (27.1%). Moderate and severe DKA were reported in 37.2% and 28.8% of cases, respectively. At admission, hypokalemia was reported in 8.5% (5/59), hyponatremia in 93.2%, and acute kidney injury in 10.2%. During treatment, hypokalemia and hypophosphatemia were reported in 24% and 45%, respectively. Mean reported blood-gas values improved from pH 7.12 and bicarbonate 8.8 mmol/L before treatment to pH 7.33 and bicarbonate 16.0 mmol/L after treatment. No in-hospital deaths were reported. In this hospital-based series, DKA frequently accompanied the initial diagnosis of type 1 diabetes, and electrolyte disturbances were reported both at admission and during treatment. No in-hospital deaths were recorded. The results support continued attention to early recognition of diabetes, timely referral, and systematic biochemical monitoring during DKA treatment.