Hypertension despite dehydration during severe pediatric diabetic ketoacidosis
Deeter KH, Roberts JS, Bradford H, Richards T, Shaw D, Marro K, Chiu H, Pihoker C, Lynn A, Vavilala MS. Hypertension despite dehydration during severe pediatric diabetic ketoacidosis. Objective: Diabetic ketoacidosis (DKA) may result in both dehydration and cerebral edema but these processes may hav...
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| Veröffentlicht in: | Pediatric diabetes 2011-06, Vol.12 (4pt1), p.295-301 |
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| creator | Deeter, Kristina H Roberts, Joan S Bradford, Heidi Richards, Todd Shaw, Dennis Marro, Kenneth Chiu, Harvey Pihoker, Catherine Lynn, Anne Vavilala, Monica S |
| description | Deeter KH, Roberts JS, Bradford H, Richards T, Shaw D, Marro K, Chiu H, Pihoker C, Lynn A, Vavilala MS. Hypertension despite dehydration during severe pediatric diabetic ketoacidosis.
Objective: Diabetic ketoacidosis (DKA) may result in both dehydration and cerebral edema but these processes may have opposing effects on blood pressure. We examined the relationship between dehydration and blood pressure in pediatric DKA.
Design: A retrospective review was performed at Seattle Children's Hospital, Seattle, WA. Participants were hospitalized children less than 18 yr. Intervention(s) or main exposure was to patients with DKA (venous pH < 7.3, glucose > 300 mg/dL, HCO3 < 15 mEq/L, and urinary ketosis). Dehydration was calculated as percent body weight lost at admission compared to discharge. Hypertension (systolic and/or diastolic blood pressure (DBP) percentile > 95%) was defined based on National Heart, Lung, and Blood Institute (NHLBI, 2004) nomograms and hypotension was defined as systolic blood pressure (SBP) |
| doi_str_mv | 10.1111/j.1399-5448.2010.00695.x |
| format | Article |
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Objective: Diabetic ketoacidosis (DKA) may result in both dehydration and cerebral edema but these processes may have opposing effects on blood pressure. We examined the relationship between dehydration and blood pressure in pediatric DKA.
Design: A retrospective review was performed at Seattle Children's Hospital, Seattle, WA. Participants were hospitalized children less than 18 yr. Intervention(s) or main exposure was to patients with DKA (venous pH < 7.3, glucose > 300 mg/dL, HCO3 < 15 mEq/L, and urinary ketosis). Dehydration was calculated as percent body weight lost at admission compared to discharge. Hypertension (systolic and/or diastolic blood pressure (DBP) percentile > 95%) was defined based on National Heart, Lung, and Blood Institute (NHLBI, 2004) nomograms and hypotension was defined as systolic blood pressure (SBP) <70 + 2 [age].
Results: Thirty‐three patients (median 10.9 yr; range 10 months to 17 yr) were included. Fifty‐eight percent of patients (19/33) had hypertension on admission before treatment and 82% had hypertension during the first 6 h of admission. None had admission hypotension. Hypertension 48 h after treatment and weeks after discharge was common (28 and 19%, respectively). Based on weight gained by discharge, 27% of patients had mild, 61% had moderate, and 12% presented with severe dehydration.
Conclusion: Despite dehydration, most children admitted with severe DKA had hypertension.</description><identifier>ISSN: 1399-543X</identifier><identifier>EISSN: 1399-5448</identifier><identifier>DOI: 10.1111/j.1399-5448.2010.00695.x</identifier><identifier>PMID: 21443581</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adolescent ; Blood Pressure ; Brain Edema - etiology ; Child ; Dehydration - etiology ; diabetes ; Diabetic Ketoacidosis - physiopathology ; Female ; Humans ; hypertension ; Hypertension - etiology ; Infant ; Male ; pediatric ; Retrospective Studies</subject><ispartof>Pediatric diabetes, 2011-06, Vol.12 (4pt1), p.295-301</ispartof><rights>2011 John Wiley & Sons A/S</rights><rights>2011 John Wiley & Sons A/S.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5115-bfd22d91e42c4e6f40e284a310645f2efb94ba8986ba506c74bb25e49567dff43</citedby><cites>FETCH-LOGICAL-c5115-bfd22d91e42c4e6f40e284a310645f2efb94ba8986ba506c74bb25e49567dff43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1399-5448.2010.00695.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1399-5448.2010.00695.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1417,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21443581$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Deeter, Kristina H</creatorcontrib><creatorcontrib>Roberts, Joan S</creatorcontrib><creatorcontrib>Bradford, Heidi</creatorcontrib><creatorcontrib>Richards, Todd</creatorcontrib><creatorcontrib>Shaw, Dennis</creatorcontrib><creatorcontrib>Marro, Kenneth</creatorcontrib><creatorcontrib>Chiu, Harvey</creatorcontrib><creatorcontrib>Pihoker, Catherine</creatorcontrib><creatorcontrib>Lynn, Anne</creatorcontrib><creatorcontrib>Vavilala, Monica S</creatorcontrib><title>Hypertension despite dehydration during severe pediatric diabetic ketoacidosis</title><title>Pediatric diabetes</title><addtitle>Pediatr Diabetes</addtitle><description>Deeter KH, Roberts JS, Bradford H, Richards T, Shaw D, Marro K, Chiu H, Pihoker C, Lynn A, Vavilala MS. Hypertension despite dehydration during severe pediatric diabetic ketoacidosis.
Objective: Diabetic ketoacidosis (DKA) may result in both dehydration and cerebral edema but these processes may have opposing effects on blood pressure. We examined the relationship between dehydration and blood pressure in pediatric DKA.
Design: A retrospective review was performed at Seattle Children's Hospital, Seattle, WA. Participants were hospitalized children less than 18 yr. Intervention(s) or main exposure was to patients with DKA (venous pH < 7.3, glucose > 300 mg/dL, HCO3 < 15 mEq/L, and urinary ketosis). Dehydration was calculated as percent body weight lost at admission compared to discharge. Hypertension (systolic and/or diastolic blood pressure (DBP) percentile > 95%) was defined based on National Heart, Lung, and Blood Institute (NHLBI, 2004) nomograms and hypotension was defined as systolic blood pressure (SBP) <70 + 2 [age].
Results: Thirty‐three patients (median 10.9 yr; range 10 months to 17 yr) were included. Fifty‐eight percent of patients (19/33) had hypertension on admission before treatment and 82% had hypertension during the first 6 h of admission. None had admission hypotension. Hypertension 48 h after treatment and weeks after discharge was common (28 and 19%, respectively). Based on weight gained by discharge, 27% of patients had mild, 61% had moderate, and 12% presented with severe dehydration.
Conclusion: Despite dehydration, most children admitted with severe DKA had hypertension.</description><subject>Adolescent</subject><subject>Blood Pressure</subject><subject>Brain Edema - etiology</subject><subject>Child</subject><subject>Dehydration - etiology</subject><subject>diabetes</subject><subject>Diabetic Ketoacidosis - physiopathology</subject><subject>Female</subject><subject>Humans</subject><subject>hypertension</subject><subject>Hypertension - etiology</subject><subject>Infant</subject><subject>Male</subject><subject>pediatric</subject><subject>Retrospective Studies</subject><issn>1399-543X</issn><issn>1399-5448</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUU1v1DAQtVARLYW_gHLjlMWOP2IfQKpKv0QpHAr0NnKSSettNgm2t9399_V2S0Rv9eWNZt57Y70hJGN0xtL7NJ8xbkwuhdCzgqYupcrI2eoV2ZsGO1PNr3bJ2xDmlLLScPGG7BZMCC412yMXp-sRfcQ-uKHPGgyji5jwZt14Gx97S-_66yzgHXrMRmycjd7VWcIKYypuMQ62ds0QXHhHXre2C_j-CffJr-Ojy8PT_PzHydnhwXleS8ZkXrVNUTSGoShqgaoVFAstLGdUCdkW2FZGVFYbrSorqapLUVWFRGGkKpu2FXyffNn6jstqgU2NffS2g9G7hfVrGKyD55Pe3cD1cAdpBVfUJIOPTwZ--LvEEGHhQo1dZ3sclgG00sZIrnli6i2z9kMIHttpC6OwuQbMYRM0bEKHzTXg8RqwStIP__9yEv6LPxE-bwn3rsP1i43h59HXs1Qlfb7VuxBxNemtvwVV8lLCn4sTOP72-1Je0e9A-QNJE6rr</recordid><startdate>201106</startdate><enddate>201106</enddate><creator>Deeter, Kristina H</creator><creator>Roberts, Joan S</creator><creator>Bradford, Heidi</creator><creator>Richards, Todd</creator><creator>Shaw, Dennis</creator><creator>Marro, Kenneth</creator><creator>Chiu, Harvey</creator><creator>Pihoker, Catherine</creator><creator>Lynn, Anne</creator><creator>Vavilala, Monica S</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201106</creationdate><title>Hypertension despite dehydration during severe pediatric diabetic ketoacidosis</title><author>Deeter, Kristina H ; Roberts, Joan S ; Bradford, Heidi ; Richards, Todd ; Shaw, Dennis ; Marro, Kenneth ; Chiu, Harvey ; Pihoker, Catherine ; Lynn, Anne ; Vavilala, Monica S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5115-bfd22d91e42c4e6f40e284a310645f2efb94ba8986ba506c74bb25e49567dff43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adolescent</topic><topic>Blood Pressure</topic><topic>Brain Edema - etiology</topic><topic>Child</topic><topic>Dehydration - etiology</topic><topic>diabetes</topic><topic>Diabetic Ketoacidosis - physiopathology</topic><topic>Female</topic><topic>Humans</topic><topic>hypertension</topic><topic>Hypertension - etiology</topic><topic>Infant</topic><topic>Male</topic><topic>pediatric</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Deeter, Kristina H</creatorcontrib><creatorcontrib>Roberts, Joan S</creatorcontrib><creatorcontrib>Bradford, Heidi</creatorcontrib><creatorcontrib>Richards, Todd</creatorcontrib><creatorcontrib>Shaw, Dennis</creatorcontrib><creatorcontrib>Marro, Kenneth</creatorcontrib><creatorcontrib>Chiu, Harvey</creatorcontrib><creatorcontrib>Pihoker, Catherine</creatorcontrib><creatorcontrib>Lynn, Anne</creatorcontrib><creatorcontrib>Vavilala, Monica S</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pediatric diabetes</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Deeter, Kristina H</au><au>Roberts, Joan S</au><au>Bradford, Heidi</au><au>Richards, Todd</au><au>Shaw, Dennis</au><au>Marro, Kenneth</au><au>Chiu, Harvey</au><au>Pihoker, Catherine</au><au>Lynn, Anne</au><au>Vavilala, Monica S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hypertension despite dehydration during severe pediatric diabetic ketoacidosis</atitle><jtitle>Pediatric diabetes</jtitle><addtitle>Pediatr Diabetes</addtitle><date>2011-06</date><risdate>2011</risdate><volume>12</volume><issue>4pt1</issue><spage>295</spage><epage>301</epage><pages>295-301</pages><issn>1399-543X</issn><eissn>1399-5448</eissn><abstract>Deeter KH, Roberts JS, Bradford H, Richards T, Shaw D, Marro K, Chiu H, Pihoker C, Lynn A, Vavilala MS. Hypertension despite dehydration during severe pediatric diabetic ketoacidosis.
Objective: Diabetic ketoacidosis (DKA) may result in both dehydration and cerebral edema but these processes may have opposing effects on blood pressure. We examined the relationship between dehydration and blood pressure in pediatric DKA.
Design: A retrospective review was performed at Seattle Children's Hospital, Seattle, WA. Participants were hospitalized children less than 18 yr. Intervention(s) or main exposure was to patients with DKA (venous pH < 7.3, glucose > 300 mg/dL, HCO3 < 15 mEq/L, and urinary ketosis). Dehydration was calculated as percent body weight lost at admission compared to discharge. Hypertension (systolic and/or diastolic blood pressure (DBP) percentile > 95%) was defined based on National Heart, Lung, and Blood Institute (NHLBI, 2004) nomograms and hypotension was defined as systolic blood pressure (SBP) <70 + 2 [age].
Results: Thirty‐three patients (median 10.9 yr; range 10 months to 17 yr) were included. Fifty‐eight percent of patients (19/33) had hypertension on admission before treatment and 82% had hypertension during the first 6 h of admission. None had admission hypotension. Hypertension 48 h after treatment and weeks after discharge was common (28 and 19%, respectively). Based on weight gained by discharge, 27% of patients had mild, 61% had moderate, and 12% presented with severe dehydration.
Conclusion: Despite dehydration, most children admitted with severe DKA had hypertension.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>21443581</pmid><doi>10.1111/j.1399-5448.2010.00695.x</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library All Journals |
| subjects | Adolescent Blood Pressure Brain Edema - etiology Child Dehydration - etiology diabetes Diabetic Ketoacidosis - physiopathology Female Humans hypertension Hypertension - etiology Infant Male pediatric Retrospective Studies |
| title | Hypertension despite dehydration during severe pediatric diabetic ketoacidosis |
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