Clinical features, predictive factors and outcome of hyperglycaemic emergencies in a developing country

Abstract

Background: Hyperglycaemic emergencies are common acute complications of diabetes mellitus (DM) but unfortunately, there is a dearth of published data on this entity from Nigeria. This study attempts to describe the clinical and laboratory scenario associated with this complication of DM.

Comparing Biochemical Profile of Admitted Patients with the Various Groups of Hyperglycemic Emergencies

“…Nineteen subjects (18%) with hyperglycaemic emergency were presenting with diagnosis of DM for the first time. This finding is in keeping with the reports from the study done by Ehusani 17 , Ogbera et al 21 and Adesina 22 who reported prevalence rates (newly diagnosed DM) of 13.3%, 15% and 46% respectively. Another study done by Pepper et al 23 , in South Africa reported a prevalence of 11% 23 .…”

“…Diabetic ketoacidosis was found in 31% of patients and their mean (SEM) age was 43.4 (3.00) years. This finding is similar to the reports by Ehusani 27 , Ogbera et al 21 , Okoro et al 20 and Adesina 22 who, in their various studies noted the occurrence of DKA in older subjects. Nine (33.3%) of the patients with DKA were less than 30 years and this could be attributed the fact that majority of these persons had type 1 DM, which typically presents at a younger age (usually less than 30 years) 11 .…”

“…During treatment of Hyperglycaemic emergencies with hydration and insulin, there is typically a rapid decline in plasma potassium concentration as potassium re-enters the intracellular compartment 5 . Hypokalemia at presentation was noted in 9 (9%) of subjects in this study and this is similar to the reports from the study by Adesina 1 who noted hypokalemia in 8% of patients, while Ogbera et al 21 in their study reported a higher prevalence of hypokalemia (37%). Rajasoorya et al 26 reported only two cases of hypokalemia in thirtythree DKA patients they studied while Beigelman 25 in the United States reported hypokalemia in 4% of the DKA patients studied.…”

Trends of Kalemia at Diagnosis of Acidosis versus Non-Acidosis Diabetic Ketosis Décompensations in Ouagadougou (Burkina Faso)

“…Otherwise, hypokalemia was the common abnormality (17.8%). Authors report this disorder in ketosis emergencies with a frequency ranged from 5.6% to 47% [2] [13] [14], and kalemia sometimes can collapse below 2 mmol/l [13]. Because low normal or normal kalemia during these emergencies result in an absolute depletion of potassium, the risk of iatrogenic hypokalemia prompt to delay the onset of intensive insulin therapy as long as potassium is below 3.3 mmol/l [4] [15].…”

Diabetic ketoacidosis: difference between potassium determined by blood gas analysis versus plasma measurement

“…A study from India, with 68 patients, showed that the most common complications during DKA treatment were hypokalemia in 41% of the cases, hypoglycemia in 15% of the cases, and cerebral edema in 13.2% of the cases (7). In another recent study, Ogbera and cols., evaluated 111 patients with hyperglycemic emergencies, and showed that hypokalemia occurred in 37% of the cases, being considered a predictor of death (8).…”