{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T11:43:04Z","timestamp":1789645384071,"version":"4.0.0"},"reference-count":40,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2008,2,11]],"date-time":"2008-02-11T00:00:00Z","timestamp":1202688000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2008,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Hyperglycemia is common during therapy for acute lymphoblastic leukemia (ALL), but diabetic ketoacidosis (DKA) occurs rarely. Morbidity due to DKA in children with ALL has not been systematically studied.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedures<\/jats:title><jats:p>We reviewed risk factors and clinical consequences of DKA in patients undergoing therapy for ALL at SJCRH between 1991 and 2006.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>DKA occurred in 6 of 797 evaluable patients. Only older age at diagnosis of ALL was a risk factor for DKA. Four of six patients with DKA as compared to 232 of the other 791 patients were older than 10 years (<jats:italic>P<\/jats:italic>\u2009=\u20090.03). Race, sex, body mass index, leukemia immunophenotype, ALL risk category, white blood cell count at diagnosis, and treatment protocol were not associated with DKA. All patients were managed with intravenous fluids, dietary modification, and short\u2010term use of insulin. Patients were hospitalized for 4\u201312 days, with a median ICU stay of 1 day. In two patients, correction of hyperglycemia was too rapid, and two others experienced hypoglycemia due to insulin therapy. There were no permanent complications of DKA or its treatment. No patient required long\u2010term insulin use. No patient had recurrent DKA; only one of the six patients had a subsequent hyperglycemia episode. All six patients are alive in remission 6\u201313 years after diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients with hyperglycemia during treatment for ALL should be screened for clinical evidence of DKA, which may require more intensive supportive care than those without ketoacidosis. The occurrence of DKA should not lead to alteration of ALL treatment. Pediatr Blood Cancer 2008;50:1207\u20131212. \u00a9 2008 Wiley\u2010Liss, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.21505","type":"journal-article","created":{"date-parts":[[2008,2,11]],"date-time":"2008-02-11T20:21:10Z","timestamp":1202761270000},"page":"1207-1212","source":"Crossref","is-referenced-by-count":55,"title":["Diabetic ketoacidosis during therapy for pediatric acute lymphoblastic leukemia"],"prefix":"10.1002","volume":"50","author":[{"given":"Jessica R.","family":"Roberson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sailaja","family":"Raju","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Shelso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching\u2010Hon","family":"Pui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott C.","family":"Howard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2008,2,11]]},"reference":[{"key":"e_1_2_5_2_2","first-page":"72","article-title":"L\u2010asparaginase related hyperglycemia","volume":"30","author":"Iyer RS","year":"1993","journal-title":"Indian J Cancer"},{"key":"e_1_2_5_3_2","first-page":"1","article-title":"Favorable remission induction rate with twice weekly doses of L\u2010asparaginase","volume":"33","author":"Jaffe N","year":"1973","journal-title":"Cancer Res"},{"key":"e_1_2_5_4_2","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1542\/peds.49.4.590","article-title":"Comparison of daily and twice\u2010weekly schedule of L\u2010asparaginase in childhood leukemia","volume":"49","author":"Jaffe N","year":"1972","journal-title":"Pediatrics"},{"key":"e_1_2_5_5_2","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1055\/s-2007-1014907","article-title":"L\u2010Asparaginase diabetes mellitus in rabbits: Differing effects of two different schedules of L\u2010asparaginase administration","volume":"16","author":"Lavine RL","year":"1984","journal-title":"Horm Metab Res"},{"key":"e_1_2_5_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00422255"},{"key":"e_1_2_5_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/0026-0495(80)90156-0"},{"key":"e_1_2_5_8_2","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.29.7.528"},{"key":"e_1_2_5_9_2","first-page":"365","article-title":"Persistent diabetes and ketoacidosis due to L\u2010asparaginase therapy","volume":"28","author":"Varsano I","year":"1973","journal-title":"Helv Paediatr Acta"},{"key":"e_1_2_5_10_2","first-page":"457","article-title":"Hyperglycemia induced by chemotherapeutic agents used in acute lymphoblastic leukemia: Report of three cases","volume":"51","author":"Wang YJ","year":"1993","journal-title":"Zhonghua Yi Xue Za Zhi (Taipei)"},{"key":"e_1_2_5_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(81)80955-9"},{"key":"e_1_2_5_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.20320"},{"key":"e_1_2_5_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/cpt1971123487"},{"key":"e_1_2_5_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19890201)63:3<561::AID-CNCR2820630327>3.0.CO;2-0"},{"key":"e_1_2_5_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/00043426-198608010-00018"},{"key":"e_1_2_5_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/000992288302200507"},{"key":"e_1_2_5_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(78)81075-0"},{"key":"e_1_2_5_18_2","first-page":"809","article-title":"Diabetes mellitus and pancreatitis as a complication of L\u2010asparaginase therapy","volume":"30","author":"Charan VD","year":"1993","journal-title":"Indian Pediatr"},{"key":"e_1_2_5_19_2","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1542\/peds.45.4.555","article-title":"The clinical toxicities of L\u2010asparaginase in treatment of leukemia and lymphoma","volume":"45","author":"Zubrod CG","year":"1970","journal-title":"Pediatrics"},{"key":"e_1_2_5_20_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0028-1095058"},{"key":"e_1_2_5_21_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1442-200X.1998.tb01402.x"},{"key":"e_1_2_5_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.shk.0000235138.20775.36"},{"key":"e_1_2_5_23_2","first-page":"71","article-title":"Cytokine production in whole blood cell cultures of patients with B\u2010lineage acute lymphoblastic leukemia. 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