Abstract

PREDICTING AND PRECIPITATING FACTORS OF DIABETIC KETOACIDOSIS AMONG ADULT IRAQ

Dr. Razak Ali Hassan Shamaal and Dr. Thaaban Khlbas

ABSTRACT

Background: Diabetic ketoacidosis (DKA) is a common complication among adult with diabetes mellitus (DM), accounting for 14% to 31% of all diabetes-related hospital admissions; the risk of DKA in established type 1 diabetes mellitus (TIDM) is 1–10% per patient per year. Objective: The purpose of this work was to determine frequency of the predictors and the precipitating factors of DKA resulting in admission to hospital or emergency departments in adult Central Teaching Hospital in Iraq. Design: case control study. Subjects and Methods: During June thru November 2014, a sample of 27 Children with diabetic ketoacidosis (DKA) (11 males and 16 females; between 16 and 22years of age) and 28 adult with type 1 diabetes mellitus (T1DM), as a control group (14 males and 14 females; between 19.years and 21years of age) admitted to the adult Central Teaching Hospital in Iraq were studied. Data regarding history, full physical examination, and laboratory investigations (presence of glucose and/or ketones in urine, serum potassium (m.Eq/l), blood bicarbonate (mmol/L), venous pH, blood glucose (mmol/100ml), and the treatment given were recorded. Analysis was performed by using SPSS version 16, and all statistical analysis was done at 95% confidence level. Statistical significance was accepted when p ≤ 0.05. Results: Most of my patients were 18-22 years old in both cases and control groups 12(44.4%) and 10 (35.7%) respectively. The frequency of DKA was significantly higher in girls than in boys 16(59.3) vs. 11 (40.7%); p < 0.05), more than two thirds of patients with DKA 19 (70.4%) were from families with lower income as compared to16 (57.1%) of the control group, In 15 (55.6%) it was the first time they were discovered to be diabetic. Seven (58.3%) of known diabetic patients had history of previous attacks of DKA and previous attacks of hypoglycemia were encountered in 10 (83.3%) of cases. The most common precipitating causes of DKA was infection, which occurred before 12 (44.4%) of the episodes, no identifiable cause for the episode was encountered in 7 (25.9%) of cases, missing the usual dose of insulin, and stress were identified in 3 (11.1%) for each, and increased food intake was documented as a precipitating factors in 2 (7.4%) of cases. Conclusions: Infection, increased food intake, missing the usual dose of insulin, and stressful conditions are the main precipitating factors for DKA; female gender, low family income, history of previous attack of either DKA or hypoglycemia are predicting factors. Recommendations it is also recommended that the education about how to care for a adult with diabetes must be provided to the entire family unit in order to protect him from the possible episode of DKA.

Keywords: Diabetic ketoacidosis (DKA), diabetes mellitus (DM).