Endocrine Abstracts

Introduction: Severe diabetic ketoacidosis (S-DKA) is a life-threatening condition requiring immediate hospitalization and treatment. Although mostly associated with type one diabetic patients, it is also a common condition in type two diabetes mellitus (T2DM). Our objective was to determine the main clinical and metabolic alterations associated with S-DKA in T2DM patients.

Methods: We retrospectively analyzed the medical records of 27 consecutive T2DM patients with S-DKA admitted to the Department of Internal Medicine between 2009 and 2012. The following clinical and laboratory data were collected: demographics, current diabetes treatment, previous hospital admissions for DKA, precipitating factors, clinical evolution and mortality. Patients with type one diabetes mellitus were excluded.

Results: Mean age was 40±9 years, 15 (56%) women and 12 (44%) men. Mean glucose was 600±177 mg/dl, pH 6.89±0.06, serum bicarbonate 3.9±1.4 mmol/l, osmolarity 306±16 mmol/l, urinary ketones 69.4±24.5 mmol/l, and anion gap 29.9±4.2. The most common contributing factor was noncompliance with diabetes treatment (48%), followed by infection (37%), stroke (4%), and unknown causes (11%). The chief complaints were dyspnea (33%), altered consciousness (26%), malaise (26%), nausea & vomiting (11%) and abdominal pain (4%). Diabetic syndrome was present in 22% of patients. Tachycardia, tachypnea and hypotension were detected in 52, 93 and 19% respectively. DKA resolved after 17±9 h of treatment, with a mean dose of insulin infusion of 0.14±0.06 U/kg per hour. Seventy-four percent of patients were treated with bicarbonate replacement therapy. There were no deaths nor complications documented in the medical records. Length of hospital stay was 4.9±3.7 days.

Conclusion: S-DKA in T2DM is a common condition that requires medical attention. Although considered life threatening, our results indicate that a proper management can yield satisfactory outcomes without mortality or the development of major complications.