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Diabetic ketoacidosis is a metabolic emergency and one of the main causes of morbidity and mortality in diabetic children due to its formidable complications. The severity of the evolution is essentially related to the initial clinical state, hence the interest of an early diagnosis and a correct management. In this work we tried to make a global analysis of this disease. We conducted a retrospective study of 122 cases admitted to the pediatric intensive care unit at the Ibn Rochd University Hospital in Casablanca between January 2010 and January 2020. The different variables collected at admission were analyzed and compared between two groups: patients who died and those who survived. 122 cases of diabetic ketoacidosis were identified. 68 boys and 74 girls with a sex ratio of 0.91. The average age was 7.61 years. Ketoacidosis was inaugural in 62% of cases, polyuoro-polydipsic syndrome was found in all patients followed by digestive disorders and 55.6% of cases. The average GCS on admission was 12. Shock was found in 17.6% of the cases and polypnoea with Kussmaul type respiration in 71.12% of the cases. The mean values of kalaemia and natraemia were close in both groups. Bicarbonates were below normal in all patients with an average of 6.37 mmol/l. The mortality was 15%. The treatment consisted of adequate rehydration associated with insulin therapy, following the protocol of the department. Our study shows that the diagnosis of DKA must be made early and requires a well codified management. Hence the interest in raising awareness and educating physicians and the population about the signs of diabetes in children in order to reduce the frequency and severity of pediatric DKA.

The 2019 coronavirus disease (COVID-19) pandemic has introduced several challenges to the medical field. Although children have lower mortality rates from COVID-19, the presence of pre-existing terrain can worsen the picture. Because COVID-19 and diabetes are widespread conditions, its suspicion is necessary to diagnose CDA in a timely manner to improve the prognosis of COVID-19-related CDA.

Acute kidney injury (AKI) is very common in intensive care units (ICUs). Its complications are often fatal, life-threatening, and may lead to kidney impairment. This is a multicentric, prospective, and descriptive study, spread over a period of six months, from January 1, 2017 to June 30, 2017, including incident cases of AKI defined according to the AKI Network criteria seen in the ICUs of Ibn Rochd University Hospital of Casablanca. Their evolution was studied during the hospital stay at three, six, 12, and 24 months. A total of 102 patients were included, 52% of whom were female. The median age was 45.2 ±0 22.93 years (10 days-87 years). Clinically, 28.4% were oligo-anuric and 54.8% had a multivisceral failure, mainly neurological and respiratory. The median creatinine level was 37.6 mg/L ± 19.82 (8-230). AKI was mainly organic and functional in 43.1% and 40.2% of cases, respectively, and the main etiologies were dehydration, sepsis, and tumor obstruction. Dialysis was required in 25.5% of cases. When discharged from the hospital, mortality occurs in 35% of cases, total recovery of renal function was observed in 22%, progression to chronicity in 38%, and end-stage renal disease (ESRD) in 5% of cases. The progression to chronicity and ESRD increased in the 1

Pediatric sepsis is associated with high mortality rates. The mortality is even higher in low income countries, therefor, implementation of simplified protocols of recognition, evaluation and management is crucial. These protocols must be tailored to local resources. We suggest in this letter a practical protocol allowing rapid transfer of pediatric sepsis patients to the PICU.