Clinical features, mortality, hospital admission, and length of stay of a cohort of adult patients with diabetic ketoacidosis attending the emergency room of a tertiary hospital in Spain / Características clínicas, mortalidad, hospitalización y duración de la estancia de pacientes adultos con cetoacidosis diabética admitidos en un servicio de urgencias de un hospital terciario en España

AIM: To assess the clinical features, length of stay, incidence rate, mortality, and hospital admissions of patients with episodes of diabetic ketoacidosis (DKA). PATIENTS: It was conducted retrospective, cross-sectional study of 164 consecutive admissions of adult patients (2008-August 2012), with type 1 or type 2 diabetes already known or new onset. RESULTS: Mortality rate was 1.2%. The DKA episodes were mild (18.9%), moderate (31.7%), or severe (49.4%). The cumulative incidence was 2.66 cases/1000 patients with diabetes (DM) in 4.5 years. The most common causes triggering DKA were infection (33.2%) and dietary transgression and/or insulin dose omission (30.7%). A total of 12.8% of patients had new onset DM, 56.7% type 1, and 26.8% type 2 DM. Patients with type 2 DM were older and had at admission higher creatinine, BUN, osmolality, sodium, and anion gap levels. Patients with new-onset of DM had higher levels of glucose and sodium, but lower potassium levels. No differences were found in pH or bicarbonate. Admission to the intensive care unit (ICU) was required in >50% of cases (p < 0.001), and 86.6% of patients were finally admitted to a medical ward (p = 0.005). The length of stay at the ICU (p < 0.001) and hospital (p = 0.013) was significantly different depending on DKA severity. CONCLUSIONS: Most DKA episodes require hospital admission, but mortality is <2%, and length of stay at the ER and medical ward depends on type of DM and initial severity of the episode

OBJETIVO: Se investigaron las características clínicas, la duración, la tasa de incidencia, la mortalidad y los ingresos de episodios de cetoacidosis diabética (CAD). PACIENTES: Se realizó un estudio retrospectivo, transversal, con 164 admisiones consecutivas de adultos (2008-agosto 2012), con diabetes (DM) tipo 1 y 2 ya conocida o debut diabético. RESULTADOS: La tasa de mortalidad fue del 1,2%. Los episodios de CAD fueron leves (18,9%), moderados (31,7%) y graves (49,4%). La incidencia acumulada fue de 2,66 casos/1.000 pacientes con DM en 4,5 años. Las causas desencadenantes más frecuentes fueron las infecciones (33,2%) y la transgresión dietética y/u omisión de la dosis de insulina (30,7%). El 12,8% tuvieron un debut diabético, 56,7% eran DM tipo 1 y el 26,8% tipo 2. Los casos con DM tipo 2 tenían mayor edad y presentaban al ingreso mayores niveles de creatinina, BUN, osmolaridad, sodio y anion GAP. El debut diabético presentaba niveles más elevados de glucosa y sodio, pero valores más bajos de potasio. No se encontró ninguna diferencia en el pH o bicarbonato. La admisión en la unidad de cuidados intensivos (UCI) se requirió en más del 50% de los casos (p < 0,001) y un 86,6% fue finalmente ingresado en una planta de hospitalización médica (p = 0,005). La duración de las estancias en la UCI (p < 0,001) y en el hospital (p = 0,013) fueron significativamente diferentes según la gravedad de la CAD. CONCLUSIONES: La mayoría de las crisis de CAD requieren de ingreso, pero la mortalidad es inferior al 2%, variando la duración de la estancia en urgencias y hospitalización dependiendo del tipo de DM y la gravedad inicial del episodio

Clinical features, mortality, hospital admission, and length of stay of a cohort of adult patients with diabetic ketoacidosis attending the emergency room of a tertiary hospital in Spain.

AIM: To assess the clinical features, length of stay, incidence rate, mortality, and hospital admissions of patients with episodes of diabetic ketoacidosis (DKA). PATIENTS: It was conducted retrospective, cross-sectional study of 164 consecutive admissions of adult patients (2008-August 2012), with type 1 or type 2 diabetes already known or new onset. RESULTS: Mortality rate was 1.2%. The DKA episodes were mild (18.9%), moderate (31.7%), or severe (49.4%). The cumulative incidence was 2.66 cases/1000 patients with diabetes (DM) in 4.5 years. The most common causes triggering DKA were infection (33.2%) and dietary transgression and/or insulin dose omission (30.7%). A total of 12.8% of patients had new onset DM, 56.7% type 1, and 26.8% type 2 DM. Patients with type 2 DM were older and had at admission higher creatinine, BUN, osmolality, sodium, and anion gap levels. Patients with new-onset of DM had higher levels of glucose and sodium, but lower potassium levels. No differences were found in pH or bicarbonate. Admission to the intensive care unit (ICU) was required in >50% of cases (p<0.001), and 86.6% of patients were finally admitted to a medical ward (p=0.005). The length of stay at the ICU (p<0.001) and hospital (p=0.013) was significantly different depending on DKA severity. CONCLUSIONS: Most DKA episodes require hospital admission, but mortality is <2%, and length of stay at the ER and medical ward depends on type of DM and initial severity of the episode.

[Osteitis fibrosa cystica as the initial manifestation of primary hyperparathyroidism]. / Osteítis fibrosa quística como manifestación inicial de hiperparatiroidismo primario.

Primary hyperparathyroidism is a common endocrinological disease and most cases are asymptomatic. We report the case of a patient with primary hyperparathyroidism and symptomatic bone lesions. The possibility of different etiologies (adenoma vs carcinoma) according to the clinical manifestations and treatment are also discussed.

Osteítis fibrosa quística como manifestación inicial de hiperparatiroidismo primario / Osteitis fibrosa cystica as the initial manifestation of primary hyperparathyroidism

El hiperparatirioidismo primario es una enfermedad endocrina muy frecuente y, en la mayoría de los casos, asintomática. Se presenta el caso de un paciente con hiperparatiroidismo primario y lesiones óseas sintomáticas y se discute la etiología en función de los hallazgos clínicos (adenoma frente a carcinoma) y su tratamiento (AU)

Primary hyperparathyroidism is a common endocrinological disease and most cases are asymptomatic. We report the case of a patient with primary hyperparathyroidism and symptomatic bone lesions. The possibility of different etiologies (adenoma vs carcinoma) according to the clinical manifestations and treatment are also discussed (AU)