Vol 9, No 3 (2020)
Research paper
Published online: 2020-02-10

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Changes in hematological parameters during first days of diabetic ketoacidosis treatment in children with type 1 diabetes mellitus

Beata Małachowska1, Dominika Michałek1, Marta Koptas1, Wiktoria Pietras1, Wojciech Młynarski2, Agnieszka Szadkowska3, Wojciech Fendler14
Clin Diabetol 2020;9(3):149-160.


Background. Diabetic ketoacidosis (DKA) is a life-threatening complication of newly diagnosed type 1 diabetes (T1DM) and is associated with severe dehydration. The aim of the study was to evaluate the changes in hematological parameters (RBC, Hct, Hb, MCV, PLT, WBC) and their correlations with acidosis level and dehydration during ketoacidosis treatment.

Methods. The study group consisted of 262 children with newly diagnosed type 1 diabetes. Clinical data were collected from hospital discharge charts. Data considering hematological parameters were collected from two timepoints: first at admission and second up to 6 days since admission.

Results. Ketoacidosis was present in 76 patients (29.01%). The DKA group had significantly higher values of baseline RBC (p = 0.0026), Hct (p = 0.0019), Hb (p = 0.0235), PLT (p = 0.0427) and WBC count (p < 0.0001) vs. patients without DKA. Interestingly, baseline MCV level was similar between the groups (p = 0.9869). During the first days of diabetes treatment, all hematological parameters such as RBC, Hct, Hb, PLT and WBC significantly decreased in both groups (all p values < 0.0001), while MCV significantly increased after treatment (p < 0.0001). However, the latter was evident only in no-DKA group. Changes in all hematological parameters correlated positively with pH (all R > 0.3 and all p values < 0.05) in DKA group but not in no-DKA group. However, weak, positive correlations at the margin of statistical significance with pH were observed for changes in PLT (p = 0.0609) and WBC (p = 0.0811) in no-DKA group.

Conclusion. Monitoring dynamics of hematological parameters at T1DM diagnosis may be useful in esti­mating patients’ hydration status.

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  1. American Diabetes Association/ADA. Diagnosis and classification of diabetes mellitus. American Diabetes Association. Diabetes Care. 2014; 37(Suppl 1): S81–90.
  2. Cho NH, Shaw JE, Karuranga S, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018; 138: 271–281.
  3. Kitabchi AE, Umpierrez GE, Murphy MB, et al. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes Care. 2006; 29(12): 2739–2748.
  4. Li W, Huang E, Gao S. Type 1 Diabetes Mellitus and Cognitive Impairments: A Systematic Review. J Alzheimers Dis. 2017; 57(1): 29–36.
  5. Edge JA, Ford-Adams ME, Dunger DB. Causes of death in children with insulin dependent diabetes 1990–96. Arch Dis Child. 1999; 81(4): 318–323.
  6. Wolfsdorf JI, Glaser N, Agus M, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes. 2018; 19 Suppl 27: 155–177.
  7. Ugale J, Mata A, Meert KL, et al. Measured degree of dehydration in children and adolescents with type 1 diabetic ketoacidosis. Pediatr Crit Care Med. 2012; 13(2): e103–e107.
  8. Koves IH, Neutze J, Donath S, et al. The accuracy of clinical assessment of dehydration during diabetic ketoacidosis in childhood. Diabetes Care. 2004; 27(10): 2485–2487.
  9. Colucci LA, Corapi KM, Li M, et al. Fluid assessment in dialysis patients by point-of-care magnetic relaxometry. Sci Transl Med. 2019; 11(502).
  10. Armstrong LE. Assessing hydration status: the elusive gold standard. J Am Coll Nutr. 2007; 26(5 Suppl): 575S–584S.
  11. Davidson DF. Excess osmolal gap in diabetic ketoacidosis explained. Clin Chem. 2019; 38(5): 755–757.
  12. Wolfsdorf J, Craig ME, Daneman D, et al. Diabetic ketoacidosis in children and adolescents with diabetes. Pediatr Diabetes. 2009; 10 Suppl 12: 118–133.
  13. Bruck E. Laboratory tests in the analysis of states of dehydration. Pediatr Clin North Am. 1971; 18(1): 265–283.
  14. Hosten AO. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. In: Clinical Methods, 3rd edition The History, Physical, and Laboratory Examinations. 1990: 718–719.
  15. Ritchie RF, Ledue TB, Craig WY. Patient hydration: a major source of laboratory uncertainty. Clin Chem Lab Med. 2007; 45(2): 158–166.
  16. Tefferi A, Hanson CA, Inwards DJ. How to interpret and pursue an abnormal complete blood cell count in adults. Mayo Clin Proc. 2005; 80(7): 923–936.
  17. Rasouli M. Basic concepts and practical equations on osmolality: Biochemical approach. Clin Biochem. 2016; 49(12): 936–941.
  18. Burnell JM, Scribner BH, Uyeno BT, et al. The effect in humans of extracellular pH change on the relationship between serum potassium concentration and intracellular potassium. J Clin Invest. 1956; 35(9): 935–939.
  19. Schwartz GJ, Work DF. Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol. 2009; 4(11): 1832–1843.
  20. Brandow A. Pallor and Anemia. Nelson Pediatric Symptom-Based Diagnosis. 2018: 661–681.e2.
  21. Dasgupta A. Mean corpuscular volume and carbohydrate-deficient transferrin as alcohol biomarkers. In: Alcohol and its Biomarkers. 2015: 139–162.
  22. Bilici M, Tavil B, Dogru O, et al. Diabetic ketoasidosis is associated with prothrombotic tendency in children. Pediatr Hematol Oncol. 2011; 28(5): 418–424.
  23. Foster JR, Morrison G, Fraser DD. Diabetic ketoacidosis-associated stroke in children and youth. Stroke Res Treat. 2011: 219706.
  24. Xu W, Wu Hf, Ma Sg, et al. Correlation between peripheral white blood cell counts and hyperglycemic emergencies. Int J Med Sci. 2013; 10(6): 758–765.