Endocrine Abstracts

Introduction: Diabetes ketoacidosis (DKA) remains a significant cause of mortality and morbidity in patients with diabetes. We reviewed all DKA episodes occurring in a large inner city teaching hospital between January 1997 and December 2001.
Methods: A retrospective chart analysis was performed on 108 episodes of DKA identified through hospital inpatients enquiry (HIPE). DKA was defined as the triad of hyperglycaemia, ketonuria and acidosis with pH<7.35. All patients had type 1 diabetes except for 1 African patient with newly diagnosed type 2 diabetes.
Results: The mean age of patients at presentation was 30.0 plus/minus 1.27 years. Mean duration of diabetes 8.5 plus/minus 1.03 years. Presenting HbA1c was 10.9 plus/minus 0.31%. 72% episodes occur in females. 54% episodes were from repeat offenders. 14.1% had severe DKA with pH <7.0 and 48.2% had moderate DKA with pH of 7.0 to 7.24. Mean admission pH was 7.17 plus/minus SE 0.01 with serum bicarbonate of 11.3 plus/minus SE 0.63 mmol per litre. Intravenous bicarbonate infusion was given in less than 4% of cases. Mean time required for correction of pH to greater than 7.35 was 16.7 plus/minus 1.82 hours. Admission plasma glucose was 33.6 plus/minus 1.69 mmol per litre. The mean in-patient stay was 7.6 plus/minus 0.67 days. 44% required admission to the high dependency unit with a mean stay of 2.7 plus/minus 0.44 days. The most common precipitating event was poor compliance with insulin therapy (43%), followed by infection (27%), first presentation diabetes (20%), unknown in 8% and acute pancreatitis and alcohol binge at 1% each. There were no deaths.
Conclusions: DKA consumes significant health care resources. The 2 major precipitating factors in the development of DKA in this study were omission of insulin therapy and infection. Repeat offenders contribute to a significant proportion of admissions. Patient education is the key solution to reducing DKA episodes.