%0 Journal Article
%T QTc and QTd in Children with Type 1 Diabetes Mellitus during Diabetic Ketoacidosis
%A Omneya I. Youssef
%A Samar M. Farid
%J ISRN Pediatrics
%D 2012
%R 10.5402/2012/619107
%X Cardiac arrest has been described in children with diabetic ketoacidosis (DKA). Aim. To evaluate QTc and QTd in type 1 diabetic children with DKA. Methods. Twelve-lead ECG was done to 30 type 1 diabetic children with DKA at presentation and recovery. Corrected QT interval and QT dispersion (QTd) were assessed. Results. QTc and QTd mean values were significantly decreased in patients after than before DKA recovery ( ). Procedure. Sixteen patients (53, 3%) had prolonged QTc during DKA (range 451¨C538£żms) that dropped to one patient after recovery, his QTc (453£żms) returned to normal 5 days after hospital discharge. Nineteen patients (63.3%) had prolonged QTd (>50£żms) that dropped to three after recovery. The fact that three patients had normal QTc but prolonged QTd increases the privilege of QTd over QTc as a better marker for cardiac risk in those patients. Anion gap was significantly associated with QTc and QTd prolongation ( ). Patients had no electrolyte abnormalities or hypoglycemia to account for QTc or QTd prolongation. Conclusion. Prolonged QTc and QTd frequently occur in DKA positively correlated to ketosis. Cardiac monitoring for patients with DKA is mandatory. 1. Introduction Cardiac arrhythmias and arrest have been described in children with diabetic ketoacidosis and generally have been presumed to be caused by electrolyte abnormalities [1]. A previous study has reported a prolongation of QTc in children receiving ketogenic diets [2] and in other conditions associated with ketosis in absence of electrolyte [3]. The association between ketotic conditions and prolonged QTc and/or sudden death raises the suggestion of whether ketosis may directly affect cardiac repolarization and be a cause of arrhythmia and/or SCD in DKA patients. QT dispersion (QTd) is defined as the interlead variability in the duration of the QT interval in the 12-lead electrocardiogram [4]. It is a significant parameter that can be used to assess the homogeneity of cardiac repolarization and autonomic function. Prolonged QTd was previously suggested as the best predictor of cardiac death in patients with type 2 DM [5]. This study aimed to evaluate QTc and QTd in children with type 1DM during DKA. 2. Patients and Methods This study included 30 children with type 1 DM who were presented with DKA 15 were newly diagnosed and 15 were following up in the diabetes clinic. They were 15 males and 15 females, their age ranged from 5 to 13 years with a mean age years (Table 1). DKA was defined according to ISPAD criteria [6]. Patients with congenital or rheumatic heart diseases,
%U http://www.hindawi.com/journals/isrn.pediatrics/2012/619107/