Avoiding kidney, brain, and other organ damage depends on prevention.


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Subtle cognitive impairment, including short-term memory loss and lower IQ scores, may occur in children who experience acute kidney injury during diabetic ketoacidosis, according to a new study. Acute kidney injury is the gradual loss of organ function over hours or days as the kidneys stop filtering waste from the blood. The condition can also cause electrolyte and fluid imbalances, affecting other organs.


In the study, researchers identified risk factors and outcomes associated with acute kidney injury in pediatric diabetic patients by examining 1,359 diabetic ketoacidosis episodes at 13 hospitals. Kidney failure occurred in 584 or 43% of episodes. It was more common in children with previously diagnosed diabetes than in those with new-onset diabetes. Children who developed acute kidney injury were slightly older than those who didn't.


The researchers found that patients who experienced acute kidney injury were significantly more likely to have impaired short-term memory scores during the episodes and lower IQ scores after recovery, even several months later. These differences remained after adjusting for diabetic ketoacidosis severity and for demographic variables such as socioeconomic status. The study documented the high incidence of acute kidney injury in children experiencing diabetic ketoacidosis and identified a pattern of multiple organ injury involving both the kidneys and the brain.


The key to preventing kidney failure and associated organ damage is preventing diabetic ketoacidosis. Diabetic ketoacidosis can be the presenting illness in children with previously undiagnosed type 1 diabetes. In children with known diabetes, diabetic ketoacidosis occurs when insulin doses are omitted or are inadequate. During periods of increased insulin needs, such as illness, infection, major stress, or even puberty, the release of hormones such as cortisol counteracts insulin, and insulin dosing must be increased. Ketoacidosis can also occur with a malfunctioning insulin pump.


Patient and parent education are crucial for ensuring that pediatric patients maintain proper insulin dosing to control glucose levels. Nurses can help by reviewing sick-day guidelines, which call for more frequent monitoring of glucose levels and ketones, adjusting insulin doses, and preventing dehydration. Nurses should also provide guidance for when to call the health care team.-Joan Zolot, PA


Myers SR, et al JAMA Network Open 2020 Dec 1;3(12):e2025481.