Study of Clinical Profile in Diabetic Ketoacidosis and Its Outcome in relation to Bicarbonate Levels

Abstract

INTRODUCTION: Diabetic Ketoacidosis (DKA) is a common complication of diabetes which comes to the emergency as the disease diabetes turns to be the common non communicable disease affecting the world. The understanding of the pathophysiology of the sickness, features, early diagnosis, and adequate treatment of DKA, and the triggering causes, can change how the disease affects the study population. This will help to reduce the disease's rates of morbidity and mortality. OBJECTIVES: 1. To evaluate age, sex distribution , common presentation and precipitating factor in diabetes ketoacidosis. 2. To study the incidence of DKA in poorly controlled diabetes by HbA1c level. 3. To study the correlation between serum bicarbonate level and duration of hospital stay in DKA patients. 4. To study the outcome of DKA during treatment. METHODOLOGY: The study was a prospective study conducted among 46 subjects with an aim to assess the clinical profile, precipitating factors, outcome and correlation of bicarbonate level among DKA subjects. The subjects with diabetic ketoacidosis were included in the study. Patient with hyperglycaemic hyperosmolar coma, chronic renal disease, with hyperemesis gravidarum, with starvation ketosis and severe anaemia. After selecting the subjects the clinical profile including age, Sex, Total stay in Hospital, family history and treatment history was assessed. Clinical findings including level of consciousness, heart rate, respiratory rate, blood pressure, random blood sugar, renal function test, bicarbonate, plasma/urine acetone was assessed. The data was entered into Microsoft excel and analysed using SPSS 23. RESULTS: In the study the mean Age (years) among the subjects was 47.87 (± 17.15) years ranging from 17 to 85 years. Among the subjects, 28 (60.87%) were Males and 18 (39.13%) were Females. In our study among the subjects, 33 (71.74%) had Type 2 and 13 (28.26%) had Type 1 Diabetes. In the study the mean Serum Bicarbonate (mEq/L) among the subjects was 13.84 (± 3.53) ranging from 7 to 21 mEq/L. The mean HbA1C (%) among the subjects was 8.98 (± 1.07) ranging from 6.7 to 11.4. Among the subjects, 10 (21.74%) had Vomiting, 9 (19.57%) had Fever and 5 (10.87%) had Altered Sensorium/Fever. Among the subjects, 32 (69.57%) had due to Non-Compliance, 6 (13.04%) had due to Infection and 5 (10.87%) had due to Inadequate dose. Among the subjects, 43 (93.48%) had Recovered and 3 (6.52%) had Death. Comparing the Treatment History with Outcome distribution, OHA + Insulin had significantly higher proportion of death with 28.57% followed by Insulin with 5.88% and least in OHA with 0%. The mean Random Blood Sugar (mg/dl) among subjects with Death was significantly higher 600 (± 0) vs. 450.35 (± 68.02). The mean Serum Bicarbonate (mEq/L) among subjects with Death outcome was significantly lower than recovered outcome subjects was 7.6 (± 0.53) vs.14.28 (± 3.22) .The mean HbA1C (%) among Death was 10.5 (± 1.31) which is higher by 1.63 and statistically significant compared to 8.87 (± 0.98) in Recovered. Serum Bicarbonate (mEq/L) has a significantly negative correlation with Duration of Stay (days) with a correlation coefficient of -0.84. Duration of Stay (days) decreases by -0.65 times for each unit increase in Serum Bicarbonate (mEq/L). CONCLUSION: Diabetic Ketoacidosis with increased blood glucose value, decreased serum bicarbonate, and higher glycosylated haemoglobulin had death as an outcome. As the bicarbonate level decreases the duration of hospital stay increases