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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

Pediatric Critical Care Medicine: March 2013 - Volume 14 - Issue 3 - p 256–260
doi: 10.1097/PCC.0b013e318271fcb7
Feature Article

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.

1Critical Care Unit, Department of Paediatrics, Children’s Hospital, University of Western Ontario, London, Ontario, Canada.

2Department of Perioperative Medicine and Anesthesiology, University Hospital, University of Western Ontario, London, Ontario, Canada.

3Division of Haematology/Oncology, Program in Cell Biology, Hospital for Sick Children, Departments of Paediatrics and Biochemistry, University of Toronto, Toronto, Ontario, Canada.

4Centre for Critical Illness Research, London, Ontario, Canada.

5Children’s Health Research Institute, London, Ontario, Canada.

*See also p. 325.

Supported, in part, by the Department of Pediatrics’ research grants.

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