FACTORS CONTRIBUTING TO ALTERATIONS IN THE LEVEL OF CONSCIOUSNESS IN PATIENTS WITH DIABETIC KETOACIDOSIS: ANALYSIS OF 189 CASES

The relation between serum osmolality, glucose, sodium, bicarbonate, arterial pH, BUN and level of consciousness was studied in 189 patients with diabetic ketoacidosis (DKA). There was much overlap between all laboratory values among various groups, even when there was a statistically significant difference. To find a better predictor, we defined a new factor as serum osmolality/arterial pH. This factor was significantly higher in drowsy and stuporous compared with alert and drowsy patients (p=0.007 and p=0.03 respectively), but not different between stuporous and comatose patients (p= 0.46). Again much overlap could be seen between groups. There was at least one other problem, either as a coexisting or a precipitating factor, in 18 (23.3%) of the alert, 24 (29.2%) of the drowsy, 11 (43.4%) of the stuporous and 4 (57.1 %) of the comatose group. We conclude that none of these clinico-biochemical parameters can be a reliable predictor of the level of consciousness in patients with DKA, and consideration and exclusion of other conditions associated with altered consciousness that may occur in diabetics should be routine.