Basal serum cortisol levels; significant predictors to DKA duration

Diabetes mellitus is the most common pediatric endocrinal disorder. Diabetic ketoacidosis is one of the most serious life-threatening complications and might be the initial presentation. Poor management, non-compliance and infection are the main triggers for DKA. Infection leads to activation of the hypothalamic-pituitary-adrenal axis leading to the production of cortisol, sometimes excessively which might affect the illness course.

The study aimed to measure basal serum cortisol levels during DKA as a significant predictor of DKA duration and to assess the time to recovery between children with newly diagnosed diabetes compared with known diabetics presenting with and without infection.

This cross-sectional study included 207 pediatric patients presenting with DKA where serum cortisol level was measured on admission.

The mean cortisol level was 41.54 µg/dl ± 21.36 µg/dL. Cortisol levels were inversely associated with serum pH and bicarbonate level with (r = -0.544; p =<0.001) and ( r = -0.520; p = <0.001) respectively. There was a positive association of cortisol levels with the duration of DKA (r = 0.443; p =<0.001). Thirty-four children (16.40%) with cortisol levels < 18 µg/dL showed higher serum pH, and bicarbonate levels and shorter duration of DKA with a statistically significant p value <0.001.  One-hundred and fourteen (55.1%) patients with cortisol levels >34 µg/dL had lower pH, bicarbonate level, and longer duration of DKA with a statistically significant p value <0.001.

Cortisol levels on admission higher than 34 µg/dL are associated with a longer duration of DKA while levels lower than 18 ug/dl were associated with a significantly shorter duration. Therefore, it’s recommended to measure basal serum cortisol levels on admission during DKA as significant predictor to DKA duration.