CLINICAL CHARACTERISTIC, VITAL SIGN, PRECIPITATING FACTOR AND OUTCOME OF DKA AND HHS PATIENT IN EMERGENCY DEPARTMENT OF GENERAL HOSPITAL
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Abstract
Background: The results of laboratory tests are necessary to confirm the diagnosis of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). The features of the patient, symptoms, and vital signs present in the emergency department (ED) may serve as the first clue to consider the diagnosis, request laboratory testing, and start the proper initial management.
Objective: To assess the clinical characteristics, vital signs, symptoms, blood glucose, precipitating factors, length of hospital stay, and mortality rate of patients diagnosed with DKA and HHS.
Methods: This research was a retrospective study of adults diagnosed with DKA, and the combined type of DKA/HHS admitted to the hospital from January 1, 2012 to December 31, 2021. The data were obtained via inpatient medical chart and outpatient electronic medical record review and analyzed using descriptive statistics. Data were presented in forms of frequency, percentage, mean, and median (Q1, Q3) with the analysis performed on qualitative data using Chi-square test or Fisher’s exact test and quantitative data using Independent t-test or Mann-Whitney u test with the statistical significance at 0.05.
Results: In 145 diabetic individuals, a total of 177 DKA, and HHS/ combined type occurred. The most common symptom upon being admitted to the ED was tiredness and shortness of breath. The median body temperature of these patients was normal, but they had tachypnea and tachycardia and their SBP was high normal. However, their DBP and MAP were within a normal range. Confusion was more common in HHS/combined type group than DKA patients with statistical significance (55.56% VS. 19.83%, p=0.029). Infection was the most common precipitating factor in both DKA and HHS/combined type group. The mortality rate in HHS and the combined type of DKA/HHS was greater in the DKA group, although the difference was not statistically significant (22.22% VS. 16.18%, p=0.644). The median hospital stay was four days in both groups without statistical significance.
CONCLUSION AND RECOMMENDATIONS: DKA and HHS should be suspected in diabetic patients with symptoms of fatigue/shortness of breath, tachypnea or tachycardia, suspected sepsis, or those with drowsiness/confusion even without a history of diabetes. The mortality rate of DKA patients in this study was higher than that in other studies in Thailand. More research into the factors that affect patient mortality is needed to improve the patient care system in small hospitals.
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