Author(s): Y. V. L. Narasimham1, A. Krishna Murthy2, Y. Satyanarayana3
BACKGROUND AND OBJECTIVES: To compare the clinical features and biochemical profile in DKA. To assess the response in the patients with standard treatment of DKA. Clinical descriptions of polyuric states resembling diabetes mellitus have been described in the Ebers papyrus of Egypt in 15th century BC.1,2 Ayurvedic literature from the times of Charaka and Sushrutha, the ancient Indian physicians identified two forms of “MadhuMeha” (Honeyed Urine) in 400 BC.3 John Rolo of England in 1797 was one of 1st who coined the term diabetes mellitus. William Prout of England described diabetic coma during 1810–20. In 1886, Dreschfeld8 described DKA and HHNS (Hyper osmolar Hyperglycemic Non-ketotic Syndrome). In 1922 Banting, Best, Collip and Macleod isolated and clinically used insulin and later won Nobel prize for that memorable invention. SETTING: Inpatients of king George Hospital attached to Andhra Medical College, Visakhapatnam.
METHODS: Diagnosis of diabetic ketoacidosis was made according to the inclusion criteria. Hyperglycemia >250 mg/dl, acidosis with blood pH <7.3, serum bicarbonate <15 mEq/l, urine positive for ketones.
RESULTS: Of the 100 patients admitted for diabetic ketoacidosis; 84 had type 2 diabetes (84%) and 16(16%) were type I diabetes. Average age at the time of presentation was 42.9±12.9 years. The commonest precipitating factor was infection (56%) followed by other factors (28%) and irregular treatment (16%). The most common clinical features at the time of presentation were vomiting, abdominal pain, acidotic breathing and dehydration. The values for RBS, HCO3, and pH were 355.3±69.1, 14.9±3.4 and 7.2±0.1 respectively.
INTERPRETATION AND CONCLUSION: Most common precipitating factors are infection and omission of insulin or irregular treatment. Most common clinical features at the time of presentation are vomiting, abdominal pain, dehydration, acidotic breathing and tachycardia. Mortality rate in diabetic ketoacidosis is 4% and the most notable predictors of poor prognosis are; severity of altered sensorium.