Clinical Characteristics and Outcome of Diabetic Ketoacidosis: Experience at BIRDEM, Dhaka, Bangladesh

Abstract

Background: Diabetic ketoacidosis (DKA) is a medical emergency. It may be the presenting feature of diabetes mellitus, but more commonly DKA complicates diabetic patients during inter-current acute illness or if they become non-compliant to anti-diabetic medications. Early detection and treatment of DKA including underlying cause is important in determining outcome.Objectives: To describe the demographic characteristics, presentations, precipitating factors and outcome of DKA.Methods: This cross-sectional study was conducted at BIRDEM General Hospital from January 2008 to December 2011.Results: Total patients were 200 with female predominance (56%). Mean age of the study population was 37.6 years. Incidence of DKA was more in known diabetic patients (71%) than in new cases (29%), more among rural population (53%) and low income group (76.5%). Common presentations included nausea (63%), vomiting (61%), polyuria (43%), polydypsia (42.5%), fever (29%), abdominal pain (28%), shortness of breath (28%), drowsiness (20%), blurred vision (13%), leg cramps (6.5%) and coma (7%). Infection (45.5%) was the commonest precipitating cause of DKA followed by non-adherence to insulin therapy (31%). Acute pancreatitis (5%), myocardial infarction (2%), stroke (1%) and surgery (1.5%) were less common precipitating factors. Aetiology of DKA could not be identified in 14% cases. Mean random blood glucose during admission was 27.1mmol/L and mean HbA1c was 11.3%. Severe acidosis (pH<7) was less common (8.5%). Neutrophil leukocytosis was present in 87% cases, irrespective of infection. In-hospital mortality was 6.5%.Conclusion: DKA occurred in diabetic patients in over two-third of the cases. In over two-third of the study population, DKA was precipitated by infection and non-adherence to insulin treatment. So, patient education regarding treatment compliance and sick days’ management are important and may prevent many cases of DKABangladesh Crit Care J September 2015; 3 (2): 53-56

Clinical characterstics, precipitating factors and glycemic control among diabetic ketoacidosis patients admitted to university hopsital in Northwest Ethiopia: A hospital based observational study.

“…The same result was found in a research done in Nigeria (22).On the contrary abdominal pain appeared to be the most common presenting symptoms in a cross-sectional study conducted in Egypt (17) and vomiting was the major clinical presentation in a research done at Saudi Arabia (12). Nausea was the most common presentation in a study done in India (2015) (23)and Bangladesh (24). The frequent occurrence of the aforementioned symptoms in DKA patients could be due to the fact that the presence of insulin deficiency results in hyperglycemia which in turn causes an osmotic diuresis.…”

Diabetic Ketoacidosis Treatment Outcome and Associated Factors Among Adult Patients Admitted to the Emergency Department and Medical Wards at King Abdulaziz Medical City, Riyadh, Saudi Arabia

“…Nearly three-quarters of the patients who were admitted with DKA did not develop complications associated with the disease. Majority (13.45%) of our patients were complicated with AKI, which is considered low as compared to a study conducted in Bangladesh showing that 29.5% of their patients developed AKI [16]. This variation could be explained by the severity of dehydration and how early fluid replacement is initiated.…”

A Prospective Study of Risk Factors, Clinical Profile and Outcome in Patients of Diabetic Ketoacidosis (DKA) in Type II Diabetes Patients

“…A similar incidence of symptoms has been reported in previous studies done by Munro et al, Umpierrez et al, and Adhikari et al 9,19,20 A similar study from Bangladesh on 200 DKA T2DM patients also reported nausea and vomiting (63%), polyuria (43%), polydypsia (42.5%), fever (29%) and abdominal pain (28%) as the most common presenting symptoms. 21 Present study has revealed that DKA patients were having more than one precipitating factor like 53% who had poor compliance also had infection like pneumonia (24%) and UT I(22%). DKA patients also presented with stroke (7%) and MI (6%) as the precipitating factors.…”