Adult Diabetic Ketoacidosis: Precipitating Factors, Diagnostic Criteria and Management Strategies at Elobied Hospital – West Sudan

Abstract

A b s t r a c t A r t i c l e I n f oDiabetic ketoacidosis (DKA) is the most common hyperglycaemic emergency in patients with diabetes mellitus. This study aimed to determine the precipitating factors, diagnostic criteria and management strategies of adult diabetic ketoacidosis at Elobied Hospital. In this hospital-based retrospective study, the records of 53 patients who were admitted to medical wards in period from January 2015 to December 2015 were reviewed. The records of 53 patients admitted to the medical wards with diabetic ketacidosis were reviewed. Sixteen (30%) were females while 37 (70%) were males. The common presenting symptoms were polyuria (57%), polydypsia (55%), nausea and vomiting (30%), fever (30%), and epigastric pain (19%). Infections were the leading precipitating factors for DKA (47%). Malaria constituted almost half of these infections (48%). Interrupted insulin therapy was the second common precipitating factor for DKA reported in 28% of patients (noncompliance). Seventeen (32%) of patients were newly diagnosed diabetics and presented with DKA. The diagnosis of DKA was made depending on the presenting symptoms, hyperglycaemia, and the presence of glucose and acetone in the urine. Mean blood glucose level in patients with DKA was 368 ± 72 mg/dl. In this study all patients admitted with DKA were managed by giving soluble insulin for hyperglycaemia and 0.9% NaCl for correction of fluid deficit beside treatment of infections if present. Records showed no evidence of bicarbonate or potassium administration. Since the majority of cases of DKA occurs in patients who are known diabetics, this complication should be largely preventable by education of patients, health care professionals and the general public. Laboratory facilities at Elobied hospital must be improved to encourage early proper diagnosis of DKA and determine the severity of DKA to decide where the patient can be managed, in the intensive care unit or in the general medical wards. Intensive care unit (ICU) must be established to provide good care for severe DKA and other emergency cases.