Hemoglobin Levels and Resolution Time of Diabetic Ketoacidosis in Pediatric Patients

This retrospective observational study investigates whether hemoglobin (Hb) levels, measured within 0-24 hours after biochemical resolution of diabetic ketoacidosis (DKA), are associated with the time to DKA resolution in pediatric patients. DKA resolution is defined as achievement of a venous pH ≥ 7.30 and a serum bicarbonate level ≥ 15 mmol/L. Only the first documented DKA episode for each patient will be included in the analysis.

Secondary outcomes include pediatric intensive care unit (PICU) length of stay, total hospital length of stay, and DKA-related complications such as hypoglycemia, electrolyte disturbances, and suspected cerebral edema. Exploratory analyses will assess the association of pre-DKA hemoglobin levels (when available), hemoglobin levels at hospital discharge, and dehydration severity-reflected by admission hematocrit-with clinical outcomes.

Inclusion criteria

• Age between 1 and 18 years
• Diagnosis of diabetic ketoacidosis (DKA) according to ISPAD criteria
• First documented episode of DKA
• Availability of hemoglobin measurement obtained within 0-24 hours after biochemical resolution of DKA
• Availability of documented timestamps for initiation of DKA treatment and biochemical resolution

Exclusion criteria

• Hyperosmolar hyperglycemic state (HHS) or mixed DKA-HHS presentation
• Known hemoglobinopathies (e.g., thalassemia major, sickle cell disease)
• Evidence of active hemolysis documented in medical records (e.g., elevated lactate dehydrogenase, indirect hyperbilirubinemia, or low haptoglobin)
• Red blood cell transfusion administered before or during the DKA treatment period
• Missing hemoglobin measurement within the predefined post-resolution window (0-24 hours)