A study of ketoacidosis and its determining factors of mortality among the diabetic patients admitted in a tertiary hospital
Keywords:
diabetes mellitus, ketoacidosis, epidemio-clinical variables, mortalityAbstract
Introduction: Ketoacidosis is one of the acute metabolic complications of diabetes. It is more common and has a higher death rate in India &south Asia. To our knowledge, there are very few studies done on diabetic ketoacidosis in Madhya Pradesh. The aim of our study was to determine the hospital prevalence of diabetic ketoacidosis, to describe their epidemio-clinical features as well as to look for determinants of hospital mortality in patients attending Bundelkhand Medical college tertiary hospitalMethods: This is a descriptive retrospective study of diabetics admitted to this unit for ketoacidosis, over a period of 15 months (from January 1, 2021, to March 30, 2022). Results: Sixty-four patients were selected for the study. The hospital prevalence of ketoacidosis was 5.61%. The mean age of the patients was 46.3 years with a sex ratio of 0.94. Type 2 diabetes predominated in terms of frequency (62.5%). In 37.5% of cases, ketoacidosis was the inaugural diabetes. For patients known to be diabetic before admission, infection was the most common etiologic factor (48.44%), followed by discontinuation of treatment (31.25%).
Downloads
References
AlijanpourAghamaleki M, Shabanzadeh Z, Rezapour M, Bijani A, Aghajanpour F. Incidence, predisposing factors and complications of Diabetic Ketoacidosis in diabetic patients. Casp J Pediatr2016; 2:142–7.
Association AD. Diagnosis and classification of diabetes mellitus. Diabetes Care 2014;37: S81–90.
Bedaso A, Oltaye Z, Geja E, Ayalew M. Diabetic ketoacidosis among adult patients with diabetes mellitus admitted to emergency unit of Hawassa university comprehensive specialized hospital. BMC Res Notes 2019; 12:1–5.
Bellazzini MA, Meyer T. Pseudo-myocardial infarction in diabetic ketoacidosis with hyperkalemia. J Emerg Med 2010;39: e139–41.
Benoit SR, Zhang Y, Geiss LS, Gregg EW, Albright A. Trends in diabetic ketoacidosis hospitalizations and in-hospital mortality—United States, 2000–2014. Morb Mortal Wkly Rep 2018; 67:362.
Chiasson J-L, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ékoé J-M, et al. Diagnosis and treatment of diabetic ketoacidosis and the hyperglycaemic hyperosmolar state. Cmaj2003; 168:859–66.
Choleau C, Maitre J, Elie C, Barat P, Bertrand AM, de Kerdanet M, et al. Ketoacidosis at time of diagnosis of type 1 diabetes in children and adolescents: effect of a national prevention campaign. Arch PediatrOrgane Off Soc FrancaisePediatr 2014; 22:343–51.
Edo AE. Clinical profile and outcomes of adult patients with hyperglycemic emergencies managed at a tertiary care hospital in Nigeria. Niger Med J J Niger Med Assoc 2012; 53:121.
Ekpebegh CO, Longo-Mbenza B, Blanco-Blanco E. Glycosylated haemoglobin is markedly elevated in new and known diabetes patients with hyperglycaemic ketoacidosis. Afr Health Sci 2014; 14:526–32.
El HM. Epidemiology of Diabetic Ketoacidosis in National Institute of Diabetes and Endocrinology (NIDE) by: Bassyouni, A.; El Ebrashy, I.; El Hefnawy, H. Endocr. Abstr., vol. 29, Bioscientifica; 2012.
Freire AX, Umpierrez GE, Afessa B, Latif KA, Bridges L, Kitabchi AE. Predictors of intensive care unit and hospital length of stay in diabetic ketoacidosis. J Crit Care 2002; 17:207–11.
Group (US) NDD, Diabetes NI of, Diseases (US) K. Diabetes in America. National Institutes of Health, National Institute of Diabetes and Digestive …; 1995.
Guerci B, Tubiana-Rufi N, Bauduceau B, Bresson R, Cuperlier A, Delcroix C, et al. Advantages to using capillary blood ɛ-hydroxybutyrate determination for the detection and treatment of diabetic ketosis. Diabetes Metab 2005; 31:401–6.
Kakoma PK, Kadiebwe DM, Kayembe AM, Makonga PK, Bugeme M, Mukuku O. Diabetic ketoacidosis in adults in Sendwe Hospital Lubumbashi: about 51 cases. Pan Afr Med J 2014; 17:324–324.
Kanwal SK, Bando A, Kumar V. Clinical profile of diabetic ketoacidosis in Indian children. Indian J Pediatr 2012; 79:901–4.
Kerl ME. Diabetic ketoacidosis: pathophysiology and clinical and laboratory presentation. Compendium 2001; 23:220–8.
Krentz AJ. Acute metabolic complications of diabetes: diabetic ketoacidosis, hyperosmolar non-ketotic hyperglycaemia and lactic acidosis. Textb Diabetes 2003.
Kruljac I, Ćaćić M, Ćaćić P, Ostojić V, Štefanović M, Šikić A, et al. Diabetic ketosis during hyperglycemic crisis is associated with decreased all-cause mortality in patients with type 2 diabetes mellitus. Endocrine 2017; 55:139–43.
Labie D. Diabetes care in sub-Saharan Africa. Med Sci MS 2007 ;23 :320–2.
Lin S-F, Lin J-D, Huang Y-Y. Diabetic ketoacidosis: comparisons of patient characteristics, clinical presentations and outcomes today and 20 years ago. Chang Gung Med J 2005; 28:24–30.
Mahardika, I. M. R., Suyasa, I. G. P. D., Kamaryati, N. P., & Wulandari, S. K. (2021). Health literacy is strongest determinant on self-monitoring blood glucose (SMBG) type 2 DM patients during COVID-19 pandemic at public health centre in Tabanan Regency. International Journal of Health & Medical Sciences, 4(3), 288-297. https://doi.org/10.31295/ijhms.v4n3.1752
Misra S, Oliver NS. Diabetic ketoacidosis in adults. BMJ 2015;351.
Muller L, Gorter KJ, Hak E, Goudzwaard WL, Schellevis FG, Hoepelman AIM, et al. Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis 2005; 41:281–8.
Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, Heine RJ, et al. Translating the A1C assay into estimated average glucose values. Diabetes Care 2008; 31:1473–8.
Ndebele NF, Naidoo M. The management of diabetic ketoacidosis at a rural regional hospital in KwaZulu-Natal. Afr J Prim Health Care Fam Med 2018; 10:1–6.
Organization WH. Global diffusion of eHealth: making universal health coverage achievable: report of the third global survey on eHealth. World Health Organization; 2017.
Ramaesh A. Incidence and long-term outcomes of adult patients with diabetic ketoacidosis admitted to intensive care: a retrospective cohort study. J Intensive Care Soc 2016; 17:222–33.
Ridouane S, Bertal KF, Diouri A. Simple diabetic ketosis: clinical epidemiological features and principal triggers in diabetics in the Marrakech region. Diabetes Metab., vol. 35, Masson; 2009, p. A73–4.
Sabaté E, Organization WH. Adherence to long-term therapies: policy for action: meeting report, 4-5 June 2001. World Health Organization; 2001.
Sarr A, Diedhiou D, Ndour-Mbaye NM, Leye YM, Ka-Cisse MS, Leye A, et al. Ketoacidosis in type 1 diabetes mellitus: 73 cases in Dakar. Mali Med 2011; 26:50–4.
Seth P, Kaur H, Kaur M. Clinical Profile of Diabetic Ketoacidosis: A Prospective Study in a Tertiary Care Hospital. Journal of Clinical and diagnostic research. 2015, vol.9:6. Available on https://www.jcdr.net/ReadXML File.aspx?id=5995. [ Last access on 21st June22]
Shahid W, Khan F, Makda A, Kumar V, Memon S, Rizwan A. Diabetic Ketoacidosis: Clinical Characteristics and Precipitating Factors. Cureus n.d.;12: e10792. https://doi.org/10.7759/cureus.10792.
Sims DB, Sperling LS. ST-segment elevation resulting from hyperkalemia. Circulation 2005;111: e295–6.
Snorgaard O, Eskildsen PC, Vadstrup S, Nerup J. Diabetic ketoacidosis in Denmark: epidemiology, incidence rates, precipitating factors and mortality rates. J Intern Med 1989; 226:223–8.
SP, Jensen ET, Mohan V, Dabelea DA, D'Agostino RB Jr, Hamman RF, Mayer-Davis EJ, Lawrence JM, Dolan LM, Kahn MG, Madhu SV, Tandon N. Diabetic ketoacidosis at diagnosis among youth with type 1 and type 2 diabetes: Results from SEARCH (United States) and YDR (India) registries. Pediatr Diabetes. 2021 Feb;22(1):40-46. doi: 10.1111/pedi.12979. Epub 2020 Feb 17. PMID: 31943641; PMCID: PMC7748377.
Stratton IM, Adler AI, Neil HAW, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. Bmj 2000; 321:405–12.
Suryasa, I. W., Rodríguez-Gámez, M., & Koldoris, T. (2021). Health and treatment of diabetes mellitus. International Journal of Health Sciences, 5(1), i-v. https://doi.org/10.53730/ijhs.v5n1.2864
Tan H, Zhou Y, Yu Y. Characteristics of diabetic ketoacidosis in Chinese adults and adolescents–a teaching hospital-based analysis. Diabetes Res Clin Pract 2012; 97:306–12.
Tenoutasse S, Mouraux T, Dorchy H. Diabetic ketoacidosis: diagnosis, management, prevention. Rev Med Brux 2010;31: S71-6.
Umpierrez GE, Kitabchi AE. Diabetic ketoacidosis. Treat Endocrinol 2003; 2:95–108.
Westerberg DP. Diabetic ketoacidosis: evaluation and treatment. Am Fam Physician 2013; 87:337–46.
Wright J, Ruck K, Rabbitts R, Charlton M, De P, Barrett T, et al. Diabetic ketoacidosis (DKA) in Birmingham, UK, 2000—2009: an evaluation of risk factors for recurrence and mortality. Br J Diabetes Vasc Dis 2009; 9:278–82.
Xu Y, Bai J, Wang G, Zhong S, Su X, Huang Z, et al. Clinical profile of diabetic ketoacidosis in tertiary hospitals in China: a multicentre, clinic-based study. Diabet Med 2016; 33:261–8.
Published
How to Cite
Issue
Section
Copyright (c) 2022 International journal of health sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.
