Factors Contributing to Alterations in the Level of Consciousness in Patients with Diabetic Ketoacidosis: Analysis of 189 Cases

ABSTRACT

The relation between serum osmolality, glucose, sodium, bicarbonate, arterial pH, BUN and level of consciousness was studied in 189 patients with diabetic ketoacidosis [DKA]. There was much overlap between all laboratory values among various groups, even when there was a statistically significant difference. To find a better predictor, we defined a new factor as serum osmolality/arterial pH. This factor was significantly higher in drowsy and stuporous compared with alert and drowsy patients [p=0.007 and p= 0.03 respectively], but not different between stuporous and comatose patients [p= 0.46]. Again much overlap could be seen between groups. There was at least one other problem, either as a coexisting or a precipitating factor, in 18 [23.3%] of the alert, 24 [29.2%] of the drowsy, 11 [43.4%] of the stuporous and 4 [57.1%] of the comatose group. We conclude that none of these clinico-biochemical parameters can be a reliable predictor of the level of consciousness in patients with DKA, and consideration and exclusion of other conditions associated with altered consciousness that may occur in diabetics should be routine