Diabetic Ketoacidosis-Prospective Study of Clinical Profile and Outcome in a Tertiary Care Hospital
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2016, Vol 4, Issue 3
Abstract
Diabetic-Ketoacidosis (DKA) is a life threatening complication of diabetes mellitus [DM]. It classically occurs in young patient with Type 1DM However it occurs in patients with Type 2 DM and In India. Its incidence is increasing. This study was undertaken to analyse the clinical profile and its outcome of DKA mainly in adults in a tertiary care hospital. This study was under taken in Gorakhpur on 52 cases from January 2014 to December 2015. Diagnosis [10, 11] was made by the presence of hyperglycemia (Blood sugar >250 mg), acidosis (Arterial pH≤7.3) serum carbonate (≤15mEq) and ketonemia. All relevant investigations were performed and patients were treated with the aim to achieve ketone free condition and euglycemia. Fifty two cases (61.2%) out of 85 cases who had fulfilled the DKA diagnostic criteria [10, 11] constituted the clinical material whose age varies from 15 to 75 year(42.5±8.3 year) with male and female ratio of 1:1.08, Ten patient (17.0%) were of Type1DM of whom 3 (5.78) were below 20 years of age. Most of the female were from 4th(8 out of 12 cases 66.0%) and 5th (8 out of 14 cases 57.2%) decade of life. 26 cases(50%) had infection as precipitating factor. The main infection was lobar pneumonia [19.2%] pulmonary tuberculosis (15.5%) and urinary tract infection (9.6%). In Type 1DM cases the main cause of DKA was irregular and discontinuation of insulin therapy otherwise in Type 2 DM cases the irregular treatment, lack of diet control and exercise. The main presenting features were dehydration [76.9%] nausea vomiting [59.6%] and hypotension [42.3%]. Characteristic Kusmauli breathing with sweet odor (17.2%). Poor compliance was main feature for the severity of DKA. The average length of hospital stay was longer in Type1 DM [9 days] Mean fluid requirement on first day was 3.5 liter and insulin 112 IV for clearing ketonurea and acidosis. The overall mortality was 10.3%. Diabetic ketoacidosis is a fatal acute metabolic complication of diabetes mellitus with heterogeneous clinical presentation Poor compliance was associated with severity of DKA and infection precipitate the DKA easily The timely early diagnosis and treatment can avoid morbidity and mortality. Keywords: Diabetic Ketoacidosis, Diabetes Mellitus, Hyperglycemia, Metabolic Acidosis, Poor compliance, Infection
Authors and Affiliations
Rajendra Chaudhary, Rajkishore Singh, Pranesh Nigam
Keywords
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