Hypertension common among kids with diabetic ketoacidosis

Hypertension is a common phenomenon in children with diabetic ketoacidosis (DKA), a study has found.

Using data from the Paediatric Emergency Care Applied Research Network, researchers included 1,258 patients who had sufficient haemodynamic data for the present analysis. Of these, 12.2 percent (n=154) had documented hypertension at presentation.

In 36 children (2.9 percent), hypertension resolved quickly in under 2 hours. In 118 episodes (9.4 percent), hypertension lasted for 2 hours. Blood pressure was normal at baseline in 196 patients (15.6 percent) but progressed to hypertension during DKA treatment. The resulting overall rate of hypertension, developed at any time during DKA, was 27.8 percent (n=350).

The median duration of hypertension was 4.0 hours. Hypertension at presentation correlated with more severe acidosis and stage 2 or 3 acute kidney injury. Conversely, lower glucose levels or glucose-corrected sodium concentrations at baseline were associated with hypertension at presentation.

In addition, the development of hypertension at any point during DKA likewise correlated with more severe acidosis and lower scores on the Glasgow Coma Scale. Similarly, hypertension severity also directly correlated with severe acidosis, stage 2 acute kidney injury, and younger patient age.

“The development of hypertension during DKA treatment and the association of hypertension with altered mental status suggests that a central mechanism may be involved in causing abnormal haemodynamic regulation,” the researchers said.

“Further investigation of regional cerebral blood flow abnormalities during DKA is necessary to better understand these relationships and how these relate to life-threatening cerebral injuries in some children,” they added.