Endocrine Abstracts

Diabetic ketoacidosis is a well- known and a major acute complication of diabetes, mainly of the patients with type 1 diabetes. It is not uncommon in patients with type 2 diabetes. This situation is characterised by the presence of serum ketones greater than 5 mEq/l and ketonuria, a blood glucose level greater than 250 mg/dl, a blood PH less than 7.3 and a serum bicarbonate level of less than 18 mEq/l. There are different factors that cause ketoacidosis. DKA can be the initial presentation of diabetes mellitus. But there are other precipitating factors like infections which are one of the most common causes, acute myocardial infarction, cerebrovascular event or postoperative stress. Noncompliance of the patient is a major cause of DKA. The patients with DKA are dehydrated, they have a characteristic smell of acetone on the breath and a Kussmaul respiration. DKA Other symptoms are thirst, polyuria, nausea, vomiting, abdominal pain. Our prospective study includes 50 patients admitted in Emergency and Endocrinology, Diabetology and Metabolic Disorders in ‘Mother Teresa’ Hospital in Tirana during the last year with the diagnosis of diabetic ketosis or ketoacidosis. Out of 50 patients, 30 of them were with type 1 of diabetes and the others with type 2. 18 of them had DKA as the initial presentation of diabetes, 10 of them suffered from different infections like urinary tract infections or pneumonia. On the other hand, noncompliance to the treatment is still a major cause of DKA, in our study it is present in 12 patients. Nausea and vomiting were the most common symptoms (in 70% of patients). Mean fluid requirement for clearance of urinary ketones was 10 litres and mean insulin dosage was 130 units. One of the patients who came with blood PH=7, serum bicarbonates=7 mEq/l was rehydrated with 10.5 litres of liquids (NaCl or Glucose) and treated with 146 UI Insuline for 36 hours till the clearance of urinary ketones. So diabetic ketoacidosis remains an acute, life threating situation with heterogeneous clinical presentation. It is very important the early diagnosis and treatment to minimise the risk of morbidity and mortality.