Incidence of Diabetic Ketoacidosis in the Emergency Room, Hatyai Hospital

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.