RESUMEN
Background: Diabetic ketoacidosis [DKA] is a life threatening complication of Diabetes Mellitus. Diabetic ketoacidosis requires early detection, prompt assessment and immediate management. For institution of preventive measures, knowledge of risk factors present in local circumstances is pre-requisite
Objective: Our study was planned to identify the various risk factors of diabetic ketoacidosis and to determine outcome of patients during these episodes
Patients and Methods: This Case-Control Study was carried out in the Department of Medicine, Bahawal Victoria Hospital, Bahawalpur, from 1st September, 2010 to 29th February, 2012. Hundred diabetic patients aged >13 years were included. Fifty consecutive patients admitted with diabetic ketoacidosis were enrolled as cases. For each case an age and sex matched control was selected. Controls were the diabetics not having ketoacidosis. Primary end points were noted i.e. [a] Patients died in emergency room or during ward stay, [b] Patients discharged alive. The statistical analysis was done using SPSS Version 16. Multivariate analysis was carried out by comparing cases and controls. Odds ratios [Ors] for each suspected risk factor were calculated. Confidence Interval [CIs] and significance of ORs was determined through Multiple Logistic Regression Analysis
Results: Our study included 100 patients, 50 cases with ketoacidosis and 50 control patients. It was noted that 54% were males in each group. Maxfmum incidence of DKA was observed in 4th decade. 90% patients with DKA were discharged alive while 10% patients died. Cases were more likely to have infections [50 percent vs 18 percent, P< 0.001], poor compliance with treatment, [44 percent vs 12 percent, P<0.001] and newly diagnosed diabetes [16 percent vs 4 percent, P <0.063] as compared with controls. Other risk factors-identified were trauma [2%], dehydration [2%], acute pancreatitis [2%], myocardial infarction [2%] and stroke [2%]. In multivariate analysis, factors associated with a significantly increased risk of DKA were, poor compliance with treatment [Odds ratio 5.762 [95 percent confidence interval, 2.079 to 15.970]], infections [Odds ratio 4.556 [95 percent confidence interval, 1.834 to 11.316]] and recent onset diabetes [Odds ratio 4.571 [95 percent confidence interval, 0.919 to 22.729]]
Conclusion: The risk for precipitation of Diabetic Ketoacidosis significantly increases due to infections, poor compliance with treatment and in patients with new onset diabetes