The Study of Different Clinical Pattern of Diabetic Ketoacidosis and Common Precipitating Events and Independent Mortality Factors
Introduction: Diabetic Ketoacidosis (DKA) is an important cause of morbidity and mortality among diabetic patients in spite of major advances in the pathogenesis and more standardized diagnosis and treatment. Aim: To find out the different patterns of clinical presentations, common precipitatin...
Main Authors: | , , , |
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Format: | Article |
Language: | English |
Published: |
JCDR Research and Publications Private Limited
2017-04-01
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Series: | Journal of Clinical and Diagnostic Research |
Subjects: | |
Online Access: | https://jcdr.net/articles/PDF/9760/25347_CE[Ra1]_F(RK)_PF1(SwG_SS)_PFA(SwG_SS)_PF2(P_NESY).pdf |
Summary: | Introduction: Diabetic Ketoacidosis (DKA) is an important cause
of morbidity and mortality among diabetic patients in spite of
major advances in the pathogenesis and more standardized
diagnosis and treatment.
Aim: To find out the different patterns of clinical presentations,
common precipitating factors and independent mortality factors
in DKA.
Materials and Methods: This study was conducted in a tertiary
care hospital, Mysuru on 110 patients from November 2007 to
October 2009. Clinical presentation and precipitating factors of
DKA were monitored.
Univariate analysis was done to identify statistically significant
risk factors contributing to DKA mortality and was used for
multiple logistic regressions to identify independent mortality
predictors. A scoring methodology was used to identify the risk
of having multiple risk factors in an individual.
Results: In this study, the mean age was 42.33 years, with a
male to female ratio of 1.2:1. The most common complaints
were vomiting and generalized weakness seen in 55 (50%) and
49 (44.5%) cases respectively. The most common precipitating
factors were infections and poor compliance to antidiabetic
treatment seen in 57 (52%) and 23 (21%) cases respectively.
The predictors of mortality included age equal to or more than
65 years, Depressed Mental State (DMS) in the first 24 hour,
insulin requirement equal to or more than 50 units in the 12
hours to bring blood glucose to less than 300 mg%, fever in the
first 24 hours, shock in the first 24 hours, RBS persistently equal
to or more than 300 mg% even after 12 hours with standard
treatment protocol, fluid requirement equal to or more than 6 L in
the first 24 hours, pH less than 7.2 and bicarbonate less than 15
mmol/l at presentation were statistically significant predictors of
mortality. Multivariate analysis failed to identify an independent
mortality factor; but, adverse parameters of more than 5 was
significantly associated with death.
Conclusion: Risk stratification of patients with DKA is possible
from simple clinical and laboratory variables available during the
first day of hospitalization and further channeling the patients to
ICU at the correct time to prevent mortalities. |
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ISSN: | 2249-782X 0973-709X |