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Pediatric Critical Care Medicine:
doi: 10.1097/PCC.0b013e318271fcb7
Feature Article

Coagulation Assessment in Children With Diabetic Ketoacidosis*

Tran, Thai Hoa MD1; Al-Harfi, Ibrahim MD1; Harle, Christopher C. MD2; Kahr, Walter H. A. MD, PhD3; Morrison, Gavin C. MD1; Kornecki, Alik MD1,4,5

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Abstract

Objectives: To assess potential hypercoagulability during diabetic ketoacidosis in children.

Design: A prospective, controlled pilot study.

Setting: University-affiliated pediatric critical care unit and emergency department in a tertiary care children’s hospital.

Patients: Children (1–18 years) admitted with an episode of diabetic ketoacidosis and healthy children as controls. All patients with diabetic ketoacidosis managed according to a preestablished protocol.

Interventions: Thromboelastography was performed using citrated whole-blood samples drawn at the time of admission and upon biochemical and clinical resolution of diabetic ketoacidosis. Citrated whole-blood samples drawn from healthy nondiabetic children acted as control samples.

Measurements and Main Results: Fifteen patients (11.7 ± 4.1 years) in the diabetic ketoacidosis group and 20 patients (8.9 ± 4.5 years; p = 0.06) in the control group completed the study. Values for standard thromboelastography parameters (R and K time, α angle, maximum amplitude, coagulation index, and Ly30) in the diabetic ketoacidosis group, both on admission and resolution, were within the control range; thromboelastography profiles of diabetic ketoacidosis patients on admission were not significantly different from profiles obtained upon diabetic ketoacidosis resolution. The mean α-angle was significantly higher in known diabetic patients compared with newly diagnosed diabetics on admission; however, it still remained within the control normal range.

Conclusions: Thromboelastographic assay results do not reflect a hypercoagulable state in this group of children with diabetic ketoacidosis. Further investigation is required to examine the potential role of injured endothelium in the suspected hypercoagulability during diabetic ketoacidosis.

©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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