Clinical Pattern, Precipitating Factors, and Outcome of Diabetic Ketoacidosis Patients Visiting Adult Emergency at Saint Paul’s Hospital Millennium Medical College

Abstract

Introduction: Diabetic ketoacidosis (DKA) is one of the most common acute complications of diabetes mellitus. The mortality rate of DKA was higher in developing countries. Diabetes mellitus has life-threatening complications that are precipitated by various factors such as infections, trauma, cardiovascular diseases, and pregnancy. This study aimed to assess the clinical pattern, precipitating factors, and outcome of DKA. Methodology: A hospital-based cross-sectional study was done at St. Paul’s Hospital Millennium Medical College. Diabetic ketoacidosis patients who were admitted from January 1st, 2019 to December 31st, 2021 were included. The sample size was estimated using the single population proportion formula. Data were analyzed using SPSS version 25. Descriptive analysis and bivariate multiple regression analyses were used. Statistical significance was considered for variables with p < 0.05. Results: A total of 261 medical charts of diabetic patients with DKA were analyzed. Patients’ median (interquartile range) age was 35 (26–46) years, with male predominance (62.1%). Polydipsia and polyuria were the most frequent presenting symptoms. About 39.1% of diabetes was a first-time presentation with DKA while infection and insulin discontinuation were the most common precipitating factors. Sixty-four (24.5%) of the patients had bad management outcomes, with a mortality rate of 1.5%. Having moderate and severe DKA (95% CI: (2.51, 11.62)] and having a lower GCS score at presentation [AOR=3.49 (95%CI: (1.11, 10.99)] were significantly associated with poor management outcome. Conclusion: Polydipsia and polyuria were the most frequent presenting symptoms. One-fourth of DKA patients had poor management outcomes. The due focus should be given to raising the general public’s awareness about precipitating factors and overall comprehensive diabetic care.