ABSTRACT
Background: Diabetic ketoacidosis (DKA) is an acute complication of uncontrolled diabetes mellitus that is associated with increased morbidity and mortality. Objective(s): To identify independent mortality indicators in patients of DKA so as to stratify them according to risk for emergent intensive care. Material(s) and Method(s): The study sample consisted of 110 patients diagnosed of DKA admitted to SMS hospital. All the patients were treated according to standard protocol. Detailed history, type of diabetes, presence of coexisting diseases, level of consciousness, vitals, capillary blood glucose, units of regular insulin administered to decrease blood glucose to less than 250 mg/dl, liters of normal saline administered and urine output were monitored. WBC count, blood urea, serum creatinine, serum electrolytes, arterial blood pH and bicarbonate, liver function tests, HbA1c, ECG and chest X ray were done. The above parameters and relevant investigations were monitored till the patient was cured and discharged or lost to death. The data was analyzed. Result(s): Ketonuria more than 3+, glucosuria more than 4+, presence of circulatory shock, fever and/or depressed mental status in the first 24 hours, requirement of more than 6 liters of fluids in first 24 hours;pH <7.1 and HCO3 < 11meq/l at presentation, time taken to become ketone free more than 96 hours or less than 48 hours had significant association with higher rates of mortality, while patients who were normotensive or hypertensive at presentation and those who took 48-95 hours to become ketone free had significantly lower rates of mortality. Age, sex, whether diagnosed newly or established case of diabetes, type of diabetes, presence of comorbidity, number of units of insulin required to bring the blood sugar levels to less than 250mg/dl in the first 24 hours, level of blood sugar at the time of presentation did not have a significant association with mortality. Conclusion(s): Mortality was higher among those who had ketonuria >3+, glucosuria >4+, lower respiratory tract infections, presence of circulatory shock, depressed mental status, fever in the first 24 hours, pH <7.1, HCO3-<11 meq/l at presentation, duration taken to become ketone free either too early (24-48 hours) or too late (>96 hours), requirement of >6L fluid on admission. Hence the high mortality rate in this study (38.18%) was due to multi-factorial reasons. It could have been confounded by the fact that the study was conducted during the ongoing covid pandemic. Risk stratification of patients with DKA is possible from simple clinical and laboratory variables available during the first day of hospitalization and prompt recognition of the above risk factors either at admission or during the course of management in the ward has to be followed by emergent ICU care to reduce the mortality. Copyright © 2022, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.