Precipitating Factors, Biological Characteristics and Clinical Manifestations in Patients Admitted With Diabetic Ketoacidosis in Shiraz Nemazee Hospital

Diabetic ketoacidosis (DKA) is a major cause of morbidity and mortality in diabetic patients. The aim of this study is to provide comparative information and to determine the common precipitating factors, clinical manifestations, and outcome of diabetic ketoacidosis in children and adult diabetic patients. Data retrieved from case records, of 300 randomly selected children and adult diabetic patients with DKA admitted in Nemazee Hospital, Shiraz, Iran between March 2007 and March 2011 with respect to precipitating factors, clinical features, osmolality, blood glucose, serum electrolytes, and arterial PH at admission, and their outcomes were analyzed and compared. The mean age of the study population was 19.59±17.45 y. Thirty four percent with new-onset diabetes presented with diabetic ketoacidosis. The most precipitating events identified were infection, and insulin omission. The mean blood glucose, serum potassium, serum sodium, osmolality, and pH at admission were 524±184 mg/dL, 4.76± 1.1 mEq/L, 135.8± 10.38 mEq/L, 311±18 mOsm/L, and 7.10±0.16, respectively. Hyponatremia and hyperkalemia occurred in 45.1% and 19.9%, respectively. Severe acidosis was much more common in younger than older individuals the typical symptoms including polydipsia and polyuria, nausea and vomiting, abdominal pain, and body weight loss. Mortality rate was 5%, the most common cause of death being uncontrolled infection. Results showed that infection and insulin omission are the major identifiable causes of DKA, which compared to its adult form is a much more common problem amongst pediatric admissions.