Delayed Management of Insulin-Dependent Diabetes Mellitus in Children |
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| Affiliation: | 1. Emir Tas, Attending Physician, Division of Endocrinology and Diabetes, Arkansas Children''s Hospital, and Assistant Professor, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR;2. Katrin Wooley, Advanced Nurse Practitioner, Department of Pediatrics, University of Arkansas for Medical Sciences, and Division of Endocrinology and Diabetes, Arkansas Children''s Hospital, Little Rock, AR;3. Vildan Tas, Assistant Professor, Department of Pediatrics, University of Arkansas for Medical Sciences, and Attending Physician, Division of General Pediatrics, Arkansas Children''s Hospital, Little Rock, AR;4. Yu-Chi Annie Wang, Attending Physician, Division of Endocrinology and Diabetes, Arkansas Children''s Hospital, and Associate Professor, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR |
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| Abstract: | IntroductionDiabetic ketoacidosis (DKA) is a common presentation for pediatric new-onset insulin-dependent diabetes mellitus (IDDM). Delayed diagnosis is the major risk factor for DKA at disease onset.MethodTwo pediatric endocrinologists independently reviewed the admission records to assess the appropriateness of preadmission management in various health care settings.ResultsEighteen percent (n = 45) of patients with new-onset IDDM had a delayed diagnosis. Twenty-eight were misdiagnosed (respiratory [n = 9], nonspecific [n = 7], genitourinary [n = 4], gastrointestinal [n = 8] issues) and 17 were mismanaged. One child died within 4 hr of hospitalization, presumably because of a hyperosmolar coma. Forty-six percent (n = 21) of patients with delayed diagnosis presented with DKA, comprising 18% of all DKA cases.DiscussionA significant number of patients with new-onset IDDM were either misdiagnosed or mismanaged. All providers must be appropriately trained in diagnosing new-onset IDDM and follow the standard of clinical care practices. |
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| Keywords: | delayed management |
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