Incidence of Diabetic Ketoacidosis in the Emergency Room, Hatyai Hospital

Authors

  • Nattaya Promwang Emergency Department, Hatyai Hospital
  • Pran Na Rungsee Emergency Department, Hatyai Hospital

Keywords:

Hyperglycemia, Diabetic ketoacidosis, Emergency room

Abstract

Abstract

          Diabetic ketoacidosis (DKA) is a metabolic complication of diabetes mellitus, characterized by a biochemical triad of hyperglycemia, ketonemia, and metabolic acidosis. This is potentially fatal, especially for the elderly and comorbid patients. The objective of this study was to assess the incidence of DKA in the emergency room at Hatyai Hospital by a retrospective chart review of patients, who were 18-year-old and diagnosed with hyperglycemia or DKA from ICD 10. The analysis covered incidence, clinical features, laboratory results, and the disposition of the patients. The outcomes were reported as the number, ratio, percentage, and median. The results showed that 269 patients were eligible for inclusion in the study. The mean age was 56.2-years-old and most subjects had type 2 diabetes (88.8%) with a mean blood sugar level of 468.2 mg/dL. The DKA incidence was 20.8%, with all of them treated as inpatients and the patients admitted to the general ward (40.3%) and the ICU (85.7%). There was a significant increase respiratory rate, pulse rate and serum potassium. Human insulin is the most current treatment in DKA group (33.1%). Most of all patients came to the emergency room by themselves (51.7%), but there was a high incidence rate of DKA in patients who came with the emergency medical services (EMS) (33.3%). The most comorbid disease was hypertension (34.41%). All of the DKA patients fulfilled the diagnostic criteria of the 2009 criteria from The American Diabetes Association, including high blood sugar, wide anion gap metabolic acidosis, ketonemia or ketonuria with significant differences in the non-DKA group. In conclusion, the hyperglycaemic patients in the emergency room had a significant incidence of DKA less than simple hyperglycemia, but they would have severe consequences if not treated. Therefore, its still necessary to investigate all patients with hyperglycemia. As there were a variety of factors related to the diagnosis, there still needs to be further studies and to find additional relevant factors to determine hyperglycemic patients that could lead to patient care development and appropriate use of limited resources including the improvement of an emergency medical system to reach more people.

References

Davis SN, Umpierrez GE. Diabetic

ketoacidosis in type 2 diabetes mellitus -

pathophysiology and clinical presentation.

Nat Clin Pract Endocrinol Metab 2007;3:

-1.

Nyce A, Byrne R, Lubkin CL, et al. Chapter

: Diabetic ketoacidosis 9th ed. Chapel

Hill, NC: Mc-Graw Hill; 2020. p.1433-41.

Kitabchi AE, Umpierrez GE, Miles JM, et al.

Hyperglycemic crises in adult patients

with diabetes. Diabetes Care 2009;32:

-43.

Umpierrez G, Korytkowski M. Diabetic

emergencies - ketoacidosis, hyperglycaemic

hyperosmolar state, and hypoglycemia.

Nat Rev Endocrinol 2016;12:222-32.

French EK, Donihi AC, Korytkowski MT.

Diabetic ketoacidosis and hyperosmolar

hyperglycemic syndrome: A review of

acute decompensated diabetes in adult

patients. BMJ 2019;365:l1114.

Dhatariya K, Savage M. The management

of diabetic ketoacidosis in adults. 2nd ed.

United Kingdom: Joint British Diabetes

Societies (JBDS);2013.

Kitabchi AE, Wall BM. Management of

diabetic ketoacidosis. Am Fam Physician

;60:455-64.

Misra S, Oliver NS. Diabetic ketoacidosis

in adults. BMJ 2015;351:h5660.

Moraes AG, Surani S. Effects of diabetic

ketoacidosis in the respiratory system.

World J Diabetes 2019;10:16-22.

Zhong VW, Juhaeri J, Mayer-Davis EJ.

Trends in hospital admission for diabetic

ketoacidosis in adults with type 1 and 2

diabetes in England. 1998-2013:a

retrospective cohort study. Diabetes Care

;41:1870-7.

Henriksen OM, Roder ME, Prahl JB, et al.

Diabetic ketoacidosis in Denmark incidence

and mortality estimated from public

health registries. Diabetes Res Clin Pract

;76:51-6.

Hanas R, Lindgren F, Lindblad B. Diabetic

ketoacidosis and cerebral edema in

Sweden -- a 2-year pediatric population

study. Diabetic Med 2007;24:1080-5.

Hekkala A, Knip M, Veijola R. Ketoacidosis

at diagnosis of type 1 diabetes in children

in northern Finland temporal changes

over 20 years. Diabetes Care 2007;30:861-6.

Rocky M, Pereira JR, Oliveira AM, et al.

Ethnicity and young age influence the

frequency of diabetic ketoacidosis at the

onset of type 1 diabetes. Diabetes Res

Clin Pract 2007;78:259-62.

Benoit SR, Zhang Y, Geiss LS, et al. Trends

in diabetic ketoacidosis hospitalizations

and in-hospital mortality - United States,

-2014. MMWR 2018;67:362-5.

Anthanont P, Khawcharoenporn T,

Tharavanij T. Incidence and outcomes of

hyperglycemic crises: a 5-year study in a

tertiary care center in Thailand. J Med

Assoc Thai 2012;95:995-1002.

Ginde AA, Pelletier AJ, Camargo CA. The

national study of U.S. emergency department

visits with diabetic ketoacidosis, 1993-2003.

Diabetes Care 2006;29:2117-9.

Handelsman Y, Henry RR, Bloomgarden

ZT, et al. American association of clinical

endocrinologists American college of the

endocrinology position statement on the

association of SGLT-2 Inhibitors and

diabetic ketoacidosis. Endocr Pract 2016;

:753-62.

NCD Risk Factor Collaboration. Worldwide

trends in diabetes since 1980: a pooled

analysis of 751 population-based studied

with 4.4 million participants. Lancet

;387:1513-30.

Davies MJ, D’Alessio DA, Fradkin J, et al.

Management of hyperglycemia in type 2

diabetes, 2018. A consensus report by the

American diabetes association (ADA) and

the European Association for the study of

Diabetes (EASD). Diabetes Care 2018;41:

-701.

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Published

2022-12-29

How to Cite

1.
Promwang N, Na Rungsee P. Incidence of Diabetic Ketoacidosis in the Emergency Room, Hatyai Hospital. J Med Health Sci [Internet]. 2022 Dec. 29 [cited 2024 Mar. 29];29(3):81-92. Available from: https://he01.tci-thaijo.org/index.php/jmhs/article/view/260782