The management of diabetic ketoacidosis at a rural regional hospital in KwaZulu-Natal

Abstract

BackgroundDiabetic ketoacidosis (DKA) is a biochemical triad of hyperglycaemia, ketoacidosis and ketonaemia and one of the potentially life-threatening acute metabolic complications of diabetes mellitus. This study aimed at describing the clinical profile of patients presenting with DKA to a busy rural regional hospital in KwaZulu-Natal.MethodsA retrospective review of clinical notes of patients presenting with DKA to the Emergency Department was performed over a 10-month period. Data included patients’ demographic profile, clinical presentation, precipitating factors, comorbidities, biochemical profile, length of hospital stay and outcome.ResultsOne hundred and five black South African patients above the age of 12 years were included in the study. Sixty-four (60.95%) patients had type 1 diabetes mellitus (T1DM) and 41 (39.05%) patients had type 2 diabetes mellitus (T2DM). Patients with T2DM were significantly older than those with T1DM (52.1 ± 12.4 years vs. 24.4 ± 9.5 years, p < 0.0001). The acute precipitant was identified in 68 (64.76%) cases with the commonest precipitant in T1DM patients being poor adherence to treatment, whereas in T2DM, the most common precipitant was infection. Nausea and vomiting were the most common presenting symptoms with the majority of patients presenting with non-specific symptoms. Fifty-seven (54.29%) cases had pre-existing comorbidities, with higher prevalence in T2DM than T1DM patients. Glycated haemoglobin was severely elevated in the majority of patients. Patients remained hospitalised for an average of 8.9 ± 7.5 days. The mortality rate was 17.14%, and 12 of the 18 deaths occurred in patients with T2DM.ConclusionThe prevalence of DKA was higher in patients with T1DM and those with pre-existing comorbidities. The mortality rate remains alarmingly high in older patients with T2DM.

Detection and analysis of glucose metabolism‑related genes in childhood diabetes using targeted next‑generation sequencing: In pediatric population‑a hospital‑based study

“…DKA is considered a typical manifestation of T1D. With A previous report of DKA in MODY and T2DM, it is now believed that DKA can occur in all forms of diabetes (17). In the present study, an NDM case exhibited DKA and hyperglycemic hyperosmolar status, but the pathogenic variant group had a lower DKA incidence than the other groups (14 vs. 75 vs. 83.33%), suggesting that DKA incidence is lower in non-T1D cases.…”

“…In recent years, an increasing number of ketoacidosis cases without precipitating cause have been reported in children and adults with T2DM (17). It is difficult to determine the type of diabetes in the initial diagnosis of these people.…”

Clinical characterstics, precipitating factors and glycemic control among diabetic ketoacidosis patients admitted to university hopsital in Northwest Ethiopia: A hospital based observational study.

“…South Africa (30)and Bangladesh (31) revealed that infection was the major precipitant of DKA. Our finding also showed that urinary tract infection 24(47.05%) was the most common infection that precipitated DKA and our result was supported with a research evidence obtained in Jimma (10),…”

Management of diabetic ketoacidosis in adults: A narrative review

“…[ 11 18 ] However, studies from different developing countries have revealed mortality rates as high as 10%–30% for patients hospitalized for DKA. [ 19 20 21 22 ]…”