672 - Acid-Base Recovery in Pediatric DKA: A Comparison of pH Trajectory Between Hispanic and Non-Hispanic White Children

Publication Number: 4657.672

Tiffany A. Robles, Dell Children's Medical Center of Central Texas, Austin, TX, United States

Background: Diabetic ketoacidosis (DKA) is a common and potentially life-threatening complication of type 1 diabetes in children. Prior studies have identified ethnic disparities in DKA incidence and severity, with minority children more likely to present with severe acidosis when compared with non-Hispanic White children. There is a lack of research in examining the trajectory of metabolic correction and how it may vary by ethnicity. Evaluating these differences may provide insight into early treatment response and highlight opportunities to optimize care.

Objective: The primary aim of this study was to evaluate the difference in time to pH normalization between Hispanic and Non-Hispanic White children presenting with pediatric diabetic ketoacidosis (DKA).

Design/Methods: This was a single-center, retrospective cohort study of pediatric patients admitted to the ICU at DCMC in Central Texas between August 1, 2021 and August 1, 2023. Patients were 12 months to 18 years, White, with reported ethnicity as either Hispanic/Latino or Non-Hispanic/Latino. Patients were included if they presented to the ED with DKA (pH < 7.3) requiring ICU admission.

Demographic data extracted from the EMR included age, sex, race/ethnicity, and insurance type. Clinical variables included weight, admission type (initial vs. recurrent), hemoglobin A1c, DKA severity (initial pH, bicarbonate), and serial measurements of pH, bicarbonate, chloride, at hours 0, 2, 6, 12, 18, and 24 until pH and bicarbonate normalization.

Results: Hispanic or Latino patients presented with slightly lower pH and bicarbonate levels compared with non-Hispanic patients. Despite these differences at presentation, both groups exhibited gradual correction over time, with pH and bicarbonate reaching similar values by hour 24. Chloride concentrations increased steadily in both groups, with minor differences by the end of the observation period. Overall, while Hispanic or Latino patients started with slightly more severe metabolic disturbances, the trajectory of metabolic correction over the first 24 hours was generally comparable between ethnic groups.

Conclusion(s): Despite presenting with slightly more severe metabolic disturbances and higher social vulnerability, Hispanic or Latino pediatric patients with DKA demonstrated a similar trajectory of metabolic correction over the first 24 hours compared with non-Hispanic patients. This highlights the potential for equitable short-term metabolic outcomes when standardized treatment protocols are applied, even among patients with differing baseline risk factors.

Trajectory of pH correction
pH values were slightly lower at presentation among Hispanic or Latino patients (Hr 0: 7.10 vs. 7.16) compared with non-Hispanic patients. Over the first 24 hours, both groups showed gradual correction, reaching similar values by Hr 24 (7.33 vs. 7.30).

Baseline Characterstics
A total of 104 DKA episodes were identified among 90 unique pediatric patients, of whom 36 (40.0%) were Hispanic or Latino and 54 (60.0%) were not Hispanic or Latino. The mean age at presentation was higher among Hispanic or Latino patients compared with non-Hispanic patients (13.1 ± 4.3 vs. 11.2 ± 4.1 years, respectively), and mean weight was likewise greater in the Hispanic or Latino group (49.1 ± 21.8 kg vs. 38.1 ± 17.4 kg). Mean initial HbA1c values were similar between groups (11.3 ± 2.0 vs. 11.8 ± 2.3