P-423: Characteristics of diabetic ketoacidosis in a tertiary pediatric referral center: comparison between new-onset and previously diagnosed type 1 diabetes
I Bartolini, C Albuquerque, J Torres, G Werneck, J Rajão, C Belém, V Silva, F Pumputis, E Rodrigues, S Antônio, C Balbi, L Khoury, J CastroAbstract
Introduction
Diabetic ketoacidosis (DKA) remains an important cause of hospitalization and mortality in pediatric diabetes. Presentation may differ between new-onset and established disease, impacting severity and outcomes.
Objectives
To compare demographic, clinical and laboratory characteristics of pediatric DKA according to diabetes status (new-onset vs previously diagnosed type 1 diabetes).
Methods
Retrospective study of pediatric DKA admissions at a tertiary referral center (June 2021–June 2024). Cases were classified as new-onset or known type 1 diabetes. Variables were analyzed using chi-square, Fisher’s exact, Mann–Whitney, or t-tests (p<0.05).
Results
Among 208 admissions (159 patients), 44.7% were new-onset. These patients were younger (8.1 vs 12.2 years, p<0.001) and more often referred from outside the capital. Previously diagnosed patients were more likely to be adolescents (86.1% vs 29.0%, p<0.001) and female (66.1% vs 49.5%, p=0.016). New-onset cases had longer hospital stay (8.3 vs 5.2 days, p<0.001) and DKA resolution time (20.3 vs 12.2 hours, p<0.001), with greater metabolic derangement (lower bicarbonate: 5.3 vs 7.2 mEq/L, p=0.017; decreased level of consciousness: 56.2% vs 27.9%, p<0.001) and more electrolyte disturbances. Known diabetes was associated with recurrent DKA, poor glycemic control (mean HbA1c 11.7%), and more frequent identifiable triggers. No significant differences were observed in DKA severity classification or ICU admission rates between groups.
Conclusions
New-onset DKA is associated with greater metabolic severity and longer recovery, likely reflecting delayed diagnosis. Previously diagnosed patients exhibit a distinct profile characterized by recurrence, poor metabolic control and identifiable triggers, emphasizing the importance of treatment adherence. These findings support strategies for earlier diagnosis and improved long-term diabetes management, emphasizing adherence in patients with established disease.