A study to determine the clinical profile and mortality predictors of adult patients presenting with diabetes Ketoacidosis at the University Teaching Hospital in Lusaka,Zambia

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Kakusa, Mwanja
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Background: Diabetes ketoacidosis (DKA) is one of the commonly encountered diabetes mellitus emergencies in hospital setups. In Zambia, there is currently no published data on DKA. This study aimed to define the clinical profile and mortality predictors of diabetic ketoacidosis at a Zambian teaching hospital. Methods: A cross-sectional analytical study of 80 hospitalised participants with diabetes ketoacidosis at University Teaching Hospital in Lusaka, Zambia was done over a 10 month long period from October 2013 to August 2014. The data extracted included clinical presentation, precipitating factors, laboratory profile, complications and hospitalisation outcomes. Additionally, participants were dichotomised into those with coma (Glasgow Coma Scale of 8 and below) and those without coma (Glasgow Coma Scale 9 and greater). They were followed up to end of hospitalisation. Primary outcome measured was all cause in-hospital mortality. Statistical tests used were Fisher‟s Exact, Kruskal-Wallis and logistic regression. Results: The participants were equally distributed by gender. The median age was 40 years (IQR 31-57). Treatment non-compliance was the single highest identified risk factor for development of DKA (42.5%) followed by new detection of diabetes (27.5%) and infection (22.5%). The prevalence of hypokalaemia was 15% while that of coma was 12.5%. Comatose participants in the study were younger than those with higher Glasgow Coma Scale (30.0 vs. 42.5 years, p-value 0.005). They also had significantly lower baseline blood pressure readings [median systolic BP 105 mmHg vs. 120 mmHg (p-value 0.032) and median diastolic BP 60 mmHg vs. 77 mmHg (p-value 0.041)]. Additionally, comatose participants had a higher baseline respiratory rate compared to patients with higher GCS (28.5/min vs. 25/min p=0.031). They also had higher baseline admission random blood glucose readings compared to patients with higher coma scores (33.0mmol/L vs. 28.0mmol/L, p-value 0.012). Their baseline sodium and chloride levels were also higher [143.5 vs. 133 mmol/L, (p=0.006) and 4.0 vs. 4.2 mmol/L, (p=0.003) respectively]. The prevalences of hypokalaemia, hypernatraemia and hyperchloraemia were equally higher amongst the comatose group compared to non-comatose patients [40% vs. 11.4% (p= 0.038), 50% vs. 14.3% ( p=0.017) and 40% vs. 10% (p= 0.027) respectively]. Complications identified in decreasing order of magnitude were acute renal failure, hypoglycaemia, aspiration, adult respiratory distress syndrome and seizures. Mortality rate was 7.5%. There were factors associated with xiv increased risk of mortality and these were development of aspiration during DKA admission, pneumonia at baseline, development of renal failure and altered mental status. Development of renal failure was independently predictive of mortality. Conclusion: Treatment non-compliance is the commonest risk factor for development of DKA at University Teaching Hospital, Lusaka, Zambia. The mortality rate is high compared to statistics from advanced treatment centers. Development of renal failure during hospitalization with DKA is independently predictive of mortality.
Diabetes mellitus , Diabetes Ketoacidosis