A clinical study of hyperglycemic emergencies in diabetic adults presenting to a rural tertiary care centre

Abstract

Background: Diabetic Hyperglycemic Emergencies are major reasons for Intensive care unit admissions, with mortality rates of up to 30%.1 The two most serious hyperglycemic emergencies are Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. This study attempts to describe the clinical features, predictive factors, laboratory correlates and outcome (in terms of recovery with or without complications or death) of hyperglycemic emergencies in adults. Diabetic ketoacidosis and Hyperglycemic hyperosmolar state are the most serious acute metabolic complications of Diabetes mellitus that may be life threatening if not properly treated. Objectives To Study the 1. Clinical features of Hyperglycemic emergencies. 2. To identify factors predicting the outcome in terms of morbidity and mortality. Methods The following patients were included in the study:- 1. Diabetes mellitus type 1 and 2 presenting with Random blood sugar >=250 mg/dl, with either of the following-  Presence of ketone bodies in the blood or urine ketone bodies and metabolic acidosis (pH <7.30 or HCO3 <15 meq/L).  Dehydration and serum osmolality >300mOsm/kg. 2. Patients of age above 18 years. All consecutive patients presenting to S.V.S Medical College & hospital emergency with above inclusion criteria fulfilled will be included in the study after taking informed written consent. Presenting complaints, examination findings, investigations will be noted and patients will be followed up from the time of admission till discharge/death. Results: Incidence of Hyperglycemic emergencies among Diabetic patients was 8.22%. Diabetic Ketoacidosis (DKA) was 44% and Hyperglycemic hyperosmolar nonketotic state (HHS) was 56%. Majority of DKA patients cases were found in less than 30 years age group and HHS patients were common after 60 years of age. Among Hyperglycemic emergency patients studied 36% were women and 64% were men. Majority of women presented with DKA and majority of men presented with HHS. 30% had type 1 Diabetes Mellitus (DM) and 70% had type 2 DM. It was observed that DKA was more common among Type 1 DM and HHS was more common among Type 2 DM. Most common presenting clinical features were vomiting, Nausea, dehydration, altered sensorium, abdominal pain, tachycardia, vomiting, nausea, dehydration, altered sensorium, abdominal pain, tachycardia and acidotic breathing. All the symptoms were common among HHS patients except for acidotic breathing which was more common with DKA patients. Mean duration of diabetes was high among HHS patients (15years) than DKA group (8 years). Commonest precipitating factor was infection followed by discontinuation of treatment. Amongst infections, Pneumonia was the commonest in DKA patient’s cases and Sepsis and Diabetic foot were the commonest among HHS patients. Conclusion: Incidence of Diabetic Ketoacidosis (DKA) was 44% and Hyperglycemic hyperosmolar non ketotic state (HHS) was 56% during this period. Majority of DKA subjects were found in less than 30 years age group and HHS subjects were common after 60 years of age. Majority of women presented with DKA and majority of men presented with HHS. It was observed that DKA was more common among Type 1 DM and HHS was more common among Type 2 DM. All the symptoms were common among HHS patients except for acidotic breathing which was more common with DKA patients.Commonest precipitating factor was infection followed by discontinuation of treatment.