Presentation and precipitating factors of diabetic ketoacidosis at Kenyatta National Hospital

Abstract

The aim of the study was to determine the clinico-biochemical features and precipitating factors of diabetic ketoacidosis.

Cross-sectional, descriptive study carried out at KNH, Nairobi, Kenya.

Male and female patients aged 12 years and above were screened for DKA. Demographic information (age, sex) and clinical information (presenting complaints, duration of diabetes, mode of treatment, vital signs, level of consciousness, hydration status, presence of Kussmaul's breathing and any precipitating factors) were obtained from those who were recruited. Investigations done included; blood sugar, arterial BGA, HbAIC, FBC, urine microscopy cis, serum urea, creatinine, Na+, K+, Mg++,P04-, bacterial tests for septic foci and blood culture. Other tests included CXR and 12-lead ECG.

7.9% of all diabetics admitted over a nine-month period were diagnosed to have DKA. Twenty-four (51.1%) were newly diagnosed diabetics, while 23 (48.9%) were known diabetics. The mean age of the study patients was 33.66 years. The symptoms ofDKA were the usual, as seen elsewhere, with polyuria (85.1 %) and polydypsia (83%) being the most common. Thirty six (76.6%) had Kussmaul's breathing ~hile 45 (95.7%) had moderate to severe dehydration. Thirty eight (80.9%) patients had altered level of consciousness. Loss of consciousness was associated with worsening level of dehydration (p=0.028). Both newly diagnosed and known diabetics had poor glycaemic control with HbAIC of 12.27% and 13.27% respectively. However, there was no statistical difference (p=0.08). Thirty-one (65.9%) patients had leucocytosis, but this was not associated with infection (p=0.508), 31 (65.9%) patients had elevated serum creatinine level which was associated with both dehydration (p=0.02) and acidosis (p=0.04). Among the known diabetics 19 out of23.(82.6%) missed their insulin injections. Infection was noted in 14 (29.8%) patients. Fourteen (29.8%) of the study patients died.

In known diabetics, missed insulin is the commonest precipitating factor ofDKA at KNH (82.6%). DKA is a common presentation in new onset diabetes. 51.1% ofthe study patients were newly diagnosed diabetics. Majority of the patients (65.9%) presenting in DKA at KNH had renal impairment. Mortality due to DKA remains high at KNH (29.8%).