Clinical profile of diabetic ketoacidosis in adults

Abstract

Introduction: Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Recent epidemiological studies indicate that hospitalizations for DKA in the U.S. are increasing. Epidemiological studies from India are limited. We undertook this observational study to analyse the clinical profiles of DKA in adults in south India. Methods: This study was conducted in at a tertiary care center in Andhra Pradesh for one year from Aug 2010 to July 2011. Diagnosis of DKA was made by the presence of (1) Plasma glucose level of 250mg/dl or higher (2) Serum bicarbonate level of 15mEq/lt or lower (3) Arterial blood pH of 7.3 or lower or a venous blood pH of 7.25 or lower (4) Presence of moderate or large urine ketones. All the patients were treated with institutional treatment protocol. Results: Of 27 patients, 22(81%) had type2 diabetes and 5(19%) had type 1 DM .10 were females and 17 males. Age of the patients ranged between 18 to 70 years, with an average of 45.3 years. Precipitating factors were present in 60% of the admissions. Non-compliance or discontinuation of drug therapy was seen in fifty per cent of patients. Average length of hospital stay was slightly longer in type 1 than type 2 DM patients Conclusion: A significant proportion of DKA occurs in patients with type 2 diabetes and many of these cases can be prevented with proper patient education and effective communication with a health care provider during an inter-current illness.

Diabetic ketoacidosis in type 2 diabetes mellitus

“…However, studies have also analysed DKA admissions in Chinese, Pakistani and Indian populations, and further recent studies have also looked at DKA in Caucasian patients with type 2 diabetes . This indicates that the development of DKA is not just related to ethnic minorities as once was thought.…”

“…In keeping with type 1 diabetes, the triggers for DKA development are similar, with infection and omission of insulin being the most common causes …”

Diabetic Ketoacidosis: Pattern of Precipitating Causes

“…1,2 Patients with type 1 DM may present with DKA, but more commonly previously diagnosed diabetic patients (both type 1 and type 2) present with this complication. 3 Cardinal biochemical features include hyperglycaemia, hyperketonaemia and metabolic acidosis.…”

“…1,3 Noncompliance to medication is also important. [1][2][3] Tissue necrosis such as acute myocardial infarction and stroke can precipitate DKA. 2,4 In a significant number of patients, no cause can be identified.…”

“…[1][2][3] Tissue necrosis such as acute myocardial infarction and stroke can precipitate DKA. 2,4 In a significant number of patients, no cause can be identified. 1,5 Treatment includes correction of dehydration, hyperglycaemia, electrolyte imbalance and treatment of precipitating cause.…”