Clinical presentation and precipitating factors of diabetic ketoacidosis among patients admitted to intensive care unit at a tertiary hospital in Mwanza, Tanzania

Bacha

Clin Med Insights Endocrinol Diabetes

et al. 2021

Background: Diabetic Ketoacidosis (DKA) is the most common and yet potentially life-threatening acute complication of diabetes that progresses rapidly to death and requires immediate medical intervention. Objective: To assess the DKA management and treatment outcome/in-hospital mortality and its predictors among hospitalized patients with DKA at the Medical ward of Shashemene Referral Hospital (SRH). Method: A retrospective study was conducted at the Medical Ward of SRH from 01 February 2015 to 31 January 2017. A systematic random sampling technique was used to select study subjects based on the inclusion criteria. Thus, of 236 reviewed charts, only 225 patients with DKA fulfilled inclusion criteria. Treatment outcome was considered good for patients who have shown improvement at discharge, while poor for patients who left against medical advice or died in the hospital. Logistic regression analysis was done to determine independent predictors for treatment outcome/in-hospital mortality using SPSS version 20 with statistical significant at P ⩽ .05. Results: Of 225 patients with DKA, 124 (55.1%) were male. Regular insulin was prescribed to all patients and antibiotics were administered to 87 (38.7%). Potassium supplementation was given only for 28 (12.4%). Non-adherence to insulin treatment (n = 91; 40.4%) and infection (n = 66; 29.3%) were the principal DKA precipitating factors. Even though 73.8% of hospitalized patients with DKA have shown good treatment outcomes, DKA contributed 12% in-hospital mortality. The result of multivariate logistic regression analysis shown that hypoglycemia is the only independent predictor for in-hospital mortality[ P = .03]. Moreover, the independent predictors for poor DKA treatment outcome were found to be smoker [ P = .04], Urinary tract infection (UTI) relative to other co-morbid condition [ P < .001], severe hypokalemia which increase risk of poor treatment outcome by around 4 times [ P = .02], and use of Metronidazole as a concurrent medication relative to other concurrent medication [ P = .03]. Conclusion: There was a high in-hospital mortality rate due to correctable causes. This mortality is unacceptable as it was majorly related to the poor practice of potassium supplementation and hypoglycemia due to insulin. Thus, clinicians and stakeholders should have to focus on modifiable factors (hypokalemia, UTI, and hypoglycemia) to reduce poor treatment outcome/in-hospital mortality.

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Diabetic Ketoacidosis Management and Treatment Outcome at Medical Ward of Shashemene Referral Hospital, Ethiopia: A Retrospective Study

Bacha

Clin Med Insights Endocrinol Diabetes

et al. 2021

“…Therefore, continuous education remains key and utilising opportunities during clinical reviews to ensure patients know about the importance of sugar control by adhering to their medications and prevention of complications. A study in a neighboring country; Tanzania, showed similar results of a higher number (72.4%) of DKA patients being already diagnosed DM patients (Iddi et al, 2017).…”

Section: Discussionmentioning

confidence: 66%

Precipitating factors, presentation and outcomes of diabetic ketoacidosis among patients seen at moi teaching and referral hospital, eldoret kenya

Msagha,

Kamano,

Ayuo

2024

Preprint

PRECIPITATING FACTORS, PRESENTATION AND OUTCOMES OF DIABETIC KETOACIDOSIS AMONG PATIENTS SEEN AT MOI TEACHING AND REFERRAL HOSPITAL, ELDORET KENYA. Clemence Msagha1, Jemima Kamano2, Paul Ayuo3 Background: Diabetes Ketoacidosis (DKA) is a major complication of Diabetes Mellitus (DM) with a likelihood of high mortality if not managed appropriately. It is diagnosed with a triad of hyperglycemia, ketonemia and metabolic acidosis. Objectives: To describe the precipitating factors, clinical presentation and outcomes of DKA among patients attending Moi Teaching and Referral Hospital (MTRH). Methods: This prospective study involved 120 consecutively recruited participants diagnosed with DKA. Participants were drawn from the Emergency department and Diabetes Outpatient clinic and followed up in the wards and intensive care unit (ICU) in MTRH for up to 10 days. Focused history and physical examination was done. Blood sugar was measured daily; blood ketones and blood gases were measured on days 1,2,3 and 5. Precipitating factors, presentation and outcomes were summarised as frequencies and their corresponding percentages and presented in tables and charts. Results: The median age of participants was 33 years (IQR 23, 44.5). Type 1 DM represented 63.3% and type 2 DM 34.2% of the patients. The most common precipitating factors for DKA were; new onset undiagnosed DM (37.5%), missed medication (36.7%) and infection (35.8%). The most common presentation was dehydration (97.5%) with 49.2% of the patients having severe DKA while 22.5% had mild DKA. Urine and blood ketones for diagnosis of DKA were present in 46.4% and 100% of patients respectively. The median length of hospital stay was 6 days (IQR 5,7) with infection being a significant determinant (aOR 2.63). The number of days taken for DKA to resolve ranged from 1 to 5 days with a median period of 3 days (IQR 2,3). DKA in-hospital mortality was 9.2% with new onset DM being a significant determinant (uOR 5.19). Conclusion: Some of the identified DKA precipitants in the study are preventable. The impact of DKA in MTRH is notable given the significant hospital stay and mortality. Recommendation: We recommend implementation research studies that would develop and test different strategies to address the precipitants to prevent DKA. For the hospital to undertake an audit of current DKA management process with the aim of improving outcomes in terms of hospital stay and mortality.

“…1,[3][4][5][6][7] It is one of the common emergencies among patients with diabetes mellitus and is associated with considerable morbidity and mortality. 8 It is still the leading cause of death; and mortality risk is substantially increased in patients with chronically poor glycemic control and frequent DKA. 3 Frequent DKA is a serious and common health problem.…”

Section: Introductionmentioning

confidence: 99%

“…10 In Africa, the mortality rate due to DKA is unacceptably higher. 8 In developing countries, it ranges from 6% to 24%. In Ethiopia, the risk of dying from DKA is higher due to poor medical services in the country.…”

Section: Introductionmentioning

confidence: 99%

Frequency of Diabetic Ketoacidosis and Its Determinants Among Pediatric Diabetes Mellitus Patients in Northwest Ethiopia

Kidie¹,

Lakew²,

Ayele³

2021

DMSO

Background: Diabetic ketoacidosis (DKA) is one of the most common public health problems and is still a major child killer in sub-Saharan African countries, particularly Ethiopia. There are limited and inconclusive data in Amhara regional state; moreover, predictors for the incidence of DKA were not investigated before. Therefore, this study aimed to assess the frequency of DKA and its determinants among pediatric diabetes mellitus patients in public hospitals in northwest Ethiopia. Methods: An institutional-based retrospective follow-up study was conducted from September 2015 to February 2018 at selected public hospitals in northwest Ethiopia. A simple random sampling method was used to select 389 study subjects. Statistical analysis was done by R-studio version 1.1.4. Akakia's information criteria was used for model comparison and the negative binomial regression model was fitted to identify determinants for the frequency of DKA. An adjusted incidence rate ratio with 95% confidence interval was used to declare statistical significance. Results: The average frequency of DKA was 1.01 per individual. The incidence rate of DKA was increased among diabetes mellitus patients with an infection (adjusted incidence rate ratio (AIRR) = 1.41, 95% CI = 1.05-2.14), heart diseases (AIRR = 4.1, 95% CI = 1.17-14.68), treatment discontinuation (AIRR = 2.91, 95% CI = 2.02-4.22), low level of sodium (AIRR = 1.88, 95% CI = 1.22-2.89) and low dose of treatment at baseline (AIRR = 0.96, 95% CI = 0.94-0.97). Conclusion:Having an infection, heart diseases, taking a low dose of treatment, a low sodium level, and treatment discontinuation were the factors that increase the frequency of DKA.