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Study of Diabetic Ketoacidosis with Special References to the Biochemical Prognostic Marker


Affiliations
1 Former PG Resident, Department of Internal Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, India
2 Associate Professor, Department of Internal Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, India
3 Professor, Department of Internal Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, India
 

Background: Diabetes Mellitus is a clinically and genetically heterogeneous group of metabolic disorders that manifest in an abnormally high level of glucose in the blood. Diabetic Ketoacidosis (DKA) represent extremes in the spectrum of decompensated diabetes. The mortality in patients with Diabetic Ketoacidosis is rarely caused by a metabolic complication of hyperglycemia or metabolic acidosis and it is usually related to the underlying medical illness that precipitates metabolic compensation. The second most important contributor to the development of DKA is inadequate insulin treatment, commonly seen as a result of noncompliance, especially in the young population. Methods: The present study was conducted for period of 2 years. It is a hospital based prospective observational study of 60 Diabetic Ketoacidosis patients. The biochemical prognostic markers were studied. Results: The study was done for 60 patients diagnosed with Diabetic Ketoacidosis presented to the medicine department. The mean age was 55.44 years. So from the current study it was proved that, serum phosphorus and APACHE II score can be used for predicting the prognosis in the the DKA patients. The mean serum phosphate among the deceased patients (n = 8) was more as compared to the discharged patients (n = 52). Out of 60 patients, highest patients (n = 38) had infection (AFI, LRTI, pneumonia. UTI, sepsis pancreatitis, enterocolitis, AKI, viral fever) as their precipitating factors. Conclusion: APACHE II score and serum phosphorus is an important biochemical marker in the prognosis of DKA. APACHE II score is directly proportional to mortality index in DKA.

Keywords

APACHE II, Diabetic Ketoacidosis, Glasgow Coma Scale, Serum Phosphate
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  • Delaney MF, Zisman A, Kettyle WM. Diabetic Ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome. Endocrinol Metab Clin North Am. 2000; 29:683–705 https://doi.org/10.1016/S0889-8529(05)70159-6

  • Gosmanov AR. et al. Hyperglycemic Crises: Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar State (HHS). NCBI. 2018.

  • Oldenhuis CN1, Oosting SF, Gietema JA, de Vries EG. Prognostic versus predictive value of biomarkers in oncology. Eur J Cancer. 2008; 44(7):946–53. PMid: 18396036. https://doi.org/10.1016/j.ejca.2008.03.006

  • Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE I1: a severity of disease classification system. Crit Care Med 1985; 13:818–29. PMid: 3928249. https://doi.org/10.1097/00003246-198510000-00009

  • Zimmerman JE. APACHE III study design: Analytic plan for evaluation of severity and outcome. Crit Care Med. 1989; 17:S169–221. PMid: 2591237. https://doi.org/10.1097/00003246-198912001-00002

  • Matoo VK, et al. Clinical profile and treatment outcome of Diabetic Ketoacidosis. Journal of the Association of Physicians of India. 1991; 39(5):379–81.

  • Agarwal A, Ambul Y, Manish G. Prognostic factors in patients hospitalized with Diabetic Ketoacidosis. Endocrinol Metab (Seouli). 2016 Sep; 31(3):1–8. PMid: 27586452 PMCid: PMC5053055. https://doi.org/10.3803/ EnM.2016.31.3.424

  • Bedaso A. et al. Diabetic Ketoacidosis among adult patients with Diabetes Mellitus admitted to emergency unit of Hawassa university comprehensive specialized hospital. BMC. 2019; 12. PMid: 30871605 PMCid: PMC6419397. https://doi. org/10.1186/s13104-019-4186-3

  • Kitabchi AE, Umpierrez GE, Murphy MB, Kreisberg RA. Hyperglycemic crises in adult patients with diabetes: A consensus statement from the American Diabetes Association. Diabetes Care. 2006; 29:2739–48. [PubMed]. PMid: 17130218. https://doi.org/10.2337/dc06-9916

  • Barski L, Nevzorov R, Harman-Boehm I, Jotkowitz A, Rabaev E, Zektser M, et al. Comparison of Diabetic Ketoacidosis in patients with type-1 and type-2 Diabetes Mellitus. Am J Med Sci. 2013; 345:326–30. [PubMed]. PMid: 23377164. https://doi.org/10.1097/MAJ.0b013e31827424ab

  • Efstathiou SP, Tsiakou AG, Tsioulos DI, Zacharos ID, Mitromaras AG, Mastorantonakis SE, et al. A mortality prediction model in Diabetic Ketoacidosis. Clinical Endocrinology. 2002; 57(5):595–601. [PubMed] [Google Scholar]. PMid: 12390332. https://doi.org/10.1046/j.1365-2265.2002.01636.x

  • Mahesh MG, Shivaswamy RP, Chandra BS, Syed S. The study of different clinical pattern of Diabetic Ketoacidosis and common precipitating events and independent mortality factors. J Clin Diagn Res. 2017; 11(4):OC42–6. PMid: 28571190 PMCid: PMC5449836. https://doi.org/10.7860/ JCDR/2017/25347.9760

  • Ahuja W, Kumar N, Kumar S, Rizwan A. Precipitating risk factors, clinical presentation, and outcome of Diabetic Ketoacidosis in patients with type 1 diabetes. Cureus. 2019; 11(5). PMid: 31372327 PMCid: PMC6669022. https://doi. org/10.7759/cureus.4789

  • Hartalkar A, Hartalkar S, Peshwe K, Nath B. Profile of precipitating factors in Diabetic Ketoacidosis: Data from a rural teaching hospital. Journal of Preventive Medicine and Holistic Health. 2015 Jul-Dec; 1(2):92–5. https://doi. org/10.5958/2394-6776.2016.00001.1

  • Rahim M, Uddin K, Zaman S, Musa A, Rahman M, Hossain M et al. Clinical spectrum and management of Diabetic Ketoacidosis: Experience in a tertiary care hospital. Birdem Med J 2011; 1(1):15–20. https://doi.org/10.3329/birdem. v1i1.12380

  • Otieno CF, Kayima JK, Mbugua PK, Amayo AA, Mcligeyo SO. Prognostic factors in patients hospitalised with Diabetic Ketoacidosis at Kenyatta National Hospital, Nairobi. East Afr Med J. 2010; 87:66–73. [PubMed]. https:// doi.org/10.4314/eamj.v87i2.60600

  • Rahim MA. et al. Clinical characteristics and outcome of Diabetic Ketoacidosis: Experience at BIRDEM, Dhaka, Bangladesh. Bangladesh Crit Care J. 2015 Sep; 3(2):53–6. https://doi.org/10.3329/bccj.v3i2.25110

  • Kebler R, McDonald FD. Dynamic changes in serum phosphorus levels in Diabetic Ketoacidosis. 1985 Nov; 79(5):571–6. https://doi.org/10.1016/0002- 9343(85)90053-1

  • Ellemann K, Soerensen JN, Pedersen L, Edsberg B, Andersen OO. Epidemiology and treatment of Diabetic Ketoacidosis in a community population. Diabetes Care. 1984; 7:528–32. [PubMed]. PMid: 6439530. https://doi. org/10.2337/diacare.7.6.528

  • Freire AX, Umpierrez GE, Afessa B, Latif KA, Bridges L, Kitabchi AE. Predictors of intensive care unit and hospital length of stay in Diabetic Ketoacidosis. J Crit Care. 2002; 17(4):207–11. PMid: 12501147. https://doi.org/10.1053/ jcrc.2002.36755


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  • Study of Diabetic Ketoacidosis with Special References to the Biochemical Prognostic Marker

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Authors

Imran Pinjari
Former PG Resident, Department of Internal Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, India
Chetan Patil
Associate Professor, Department of Internal Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, India
Neelima Chafekar
Professor, Department of Internal Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, India
Madhuri Kirloskar
Associate Professor, Department of Internal Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, India

Abstract


Background: Diabetes Mellitus is a clinically and genetically heterogeneous group of metabolic disorders that manifest in an abnormally high level of glucose in the blood. Diabetic Ketoacidosis (DKA) represent extremes in the spectrum of decompensated diabetes. The mortality in patients with Diabetic Ketoacidosis is rarely caused by a metabolic complication of hyperglycemia or metabolic acidosis and it is usually related to the underlying medical illness that precipitates metabolic compensation. The second most important contributor to the development of DKA is inadequate insulin treatment, commonly seen as a result of noncompliance, especially in the young population. Methods: The present study was conducted for period of 2 years. It is a hospital based prospective observational study of 60 Diabetic Ketoacidosis patients. The biochemical prognostic markers were studied. Results: The study was done for 60 patients diagnosed with Diabetic Ketoacidosis presented to the medicine department. The mean age was 55.44 years. So from the current study it was proved that, serum phosphorus and APACHE II score can be used for predicting the prognosis in the the DKA patients. The mean serum phosphate among the deceased patients (n = 8) was more as compared to the discharged patients (n = 52). Out of 60 patients, highest patients (n = 38) had infection (AFI, LRTI, pneumonia. UTI, sepsis pancreatitis, enterocolitis, AKI, viral fever) as their precipitating factors. Conclusion: APACHE II score and serum phosphorus is an important biochemical marker in the prognosis of DKA. APACHE II score is directly proportional to mortality index in DKA.

Keywords


APACHE II, Diabetic Ketoacidosis, Glasgow Coma Scale, Serum Phosphate

References