The association between ketoacidosis and 25(OH)-vitamin D3 levels at presentation in children with type 1 diabetes mellitus

Huynh T, Greer RM, Nyunt O, Bowling F, Cowley D, Leong GM, Cotterill AM, Harris M. The association between ketoacidosis and 25(OH)-vitamin D-3 levels at presentation in children with type 1 diabetes mellitus.Pediatric Diabetes 2009: 10: 38-43. There is considerable evidence supporting the role of vitamin D deficiency in the pathogenesis of type 1 diabetes mellitus (T1DM). Vitamin D deficiency is also associated with impairment of insulin synthesis and secretion. There have been no formal studies looking at the relationship between 25(OH)-vitamin D-3 and the severity of diabetic ketoacidosis (DKA) in children at presentation with T1DM. To determine the relationship between measured 25(OH)-vitamin D-3 levels and the degree of acidosis in children at diagnosis with T1DM. Children presenting with new-onset T1DM at a tertiary children's hospital. 25(OH)-vitamin D-3 and bicarbonate levels were measured in children at presentation with newly diagnosed T1DM. Those with suboptimal 25(OH)-vitamin D-3 levels (< 50 nmol/L) had repeat measurements performed without interim vitamin D supplementation. Fourteen of the 64 children had low 25(OH)-vitamin D-3 levels at presentation, and 12 of these had low bicarbonate levels (< 18 mmol/L) (p = 0.001). Bicarbonate explained 20% of the variation in vitamin D level at presentation (partial r(2) = 0.20, p < 0.001) and ethnic background a further 10% (partial r(2) = 0.10, p = 0.002). The levels of 25(OH)-vitamin D-3 increased in 10 of the 11 children with resolution of the acidosis. Acid-base status should be considered when interpreting 25(OH)-vitamin D-3 levels in patients with recently diagnosed T1DM. Acidosis may alter vitamin D metabolism, or alternatively, low vitamin D may contribute to a child's risk of presenting with DKA.