Diabetic Ketoacidosis Treatment Outcome and Associated Factors Among Adult Patients Admitted to Medical Wards of Adama Hospital Medical College, Oromia, Ethiopia
American Journal of Internal Medicine
Volume 6, Issue 2, March 2018, Pages: 34-42
Received: Dec. 1, 2017; Accepted: Apr. 11, 2018; Published: May 19, 2018
Views 1502      Downloads 181
Dagim Assefa Kassaye, Department of Internal Medicine, Adama Hospital Medical College, Adama, Ethiopia
Worku Dugassa Girsha, Department of Public Health, Adama Hospital Medical College, Adama, Ethiopia
Godana Jarso Guto, Department of Internal Medicine, Adama Hospital Medical College, Adama, Ethiopia
Haji Aman Deybasso, Department of Public Health, Adama Hospital Medical College, Adama, Ethiopia
Article Tools
Follow on us
Diabetic Ketoacidosis (DKA) is one of the most serious acute complications of diabetes mellitus. The mortality rate remains high in developing countries and among misdiagnosed and treated patients. Therefore targeting early diagnosis and effective treatment programs is vital to save the life of patients. The aim of the study is to assess diabetic ketoacidosis treatment outcome and associated factors among adult patients at Adama Hospital Medical College emergency department and medical wards, Oromia region, Ethiopia. Cross sectional study based on record review of 357 adult diabetic ketoacidosis patients was selected using simple random sampling. Data was collected using checklist from medical registrations. The data was entered and analyzed using SPSS version 20 and EPI-info version 7 statistical packages. Majority of the patients (65.30%) had two or more episodes of diabetic ketoacidosis and the main reasons for recurrent diabetic ketoacidosis were infectious illness (69.50%) and insulin discontinuation (14.80%). Regarding treatment outcomes of diabetic ketoacidosis patients, majority of them (84.90%) discharged with improved. Those diabetic ketoacidosis patients treated with more than six liters fluid replacement in the 1st 24 hours had better treatment outcome by two times as compared to less than three liters fluid replacement (AOR=2.41 (1.58-10.02). Similarly, those patients who got more than sixty international unit insulin doses in the 1st 24hrs had better treatment outcome by ten times (AOR=10.68 (3.88- 20.64)) when compared to less than forty international unit insulin administration. In addition, DKA patients who got supplemental potassium showed five times treatment outcome improvement (AOR= 5.30 (2.11-13.32) than for those potassium replacement was not done. Even if majority of diabetic ketoacidosis patients treated at Adama Hospital Medical College emergency room and medical wards were discharged with improvement, early treatment of infection, ample fluid replacement and insulin dose adjustment during illness need to be encouraged.
Diabetic Ketoacidosis, Treatment Outcome, Associated Factors, Adama Hospital Medical College
To cite this article
Dagim Assefa Kassaye, Worku Dugassa Girsha, Godana Jarso Guto, Haji Aman Deybasso, Diabetic Ketoacidosis Treatment Outcome and Associated Factors Among Adult Patients Admitted to Medical Wards of Adama Hospital Medical College, Oromia, Ethiopia, American Journal of Internal Medicine. Vol. 6, No. 2, 2018, pp. 34-42. doi: 10.11648/j.ajim.20180602.12
Copyright © 2018 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Kitabchi AE, Umpierrez GE, Murphy MB, et al. Management of hyperglycemic crises in patients with diabetes. Diabetes Care. 2001; 24 (1):131–53.
Wolfsdorf J, Glaser N, Sperling MA. Diabetic ketoacidosis in infants, children, and adolescents: a consensus statement from the American Diabetes Association. Diabetes Care 2006; 29:1150–2259.
Kitabaci AE, Umpierrez GE, Murphy MB, Kreisberg RA. Hyperglycaemic crises in adult patients with diabetes. A consensus statement from the American diabetes association. Diabetes Care 2006; 29: 2739-2748.
Mbugua PK, Otieno CF, Kayima JK, Amayo AA, McLigeyo SO. Diabetic ketoacidosis: Clinical presentation and precipitating factors at Kenyatta National Hospital, Nairobi. East African Medical Journal 2005; 82 (12 Suppl):S191–6.
Alvin C. powers. Diabetes mellitus. In: Harrison, Brauwnwald, Kasper (eds.) Harrison’s Principles of Internal Medicine, 17th edition, The McGraw-Hill Companies, Inc 2008: 2275-304.
Otieno CF, Kayima JK, Omonge EO, Oyoo GO. Diabetic ketoacidosis: risk factors, mechanisms and management strategies in sub-Saharan Africa: a review. East Afr Med J 2005; 82: S197–203.
http://www.bsped.org.uk/professional/guidelines/docs/ DKAGuideline.pdf Last accessed 20 January 2017.
The-Management-of-Diabetic-Ketoacidosis-in-Adults/; http:// www.diabetes.nhs.uk/publications_and_resources/reports. Accessed 30 June 2017.
Oyarzabal Irigoyen M, etals. Ketoacidosis at onset of type 1 Diabetes mellitus in pediatric age in Spain and review of the literature. Pediatr Endocrinol Rev. 2012 Mar; 9 (3):669-71.).
http://www.cdc.gov/nchs/ about/major/hdasd/nhds.htm. Accessed 24 June 2017.
http://www.tjpr.org http://dx.doi.org/10.4314/tjpr.v14i1.25. Accessed 25 June 2017.
Chaithongdi N, Subauste JS, Koch CA, Geraci SA. Diagnosis and management of hyperglycemic emergencies. Hormones (Athens). 2011 Oct-Dec; 10 (4):250-60.
Goldberger ZD. Severe hypothermia with Osborn waves in diabetic ketoacidosis. Respir Care 2008; 53:500–2.
Umpierrez G, Freire AX. Abdominal pain in patients with hyperglycemic crises. J Crit Care 2002; 17:63–67.
Chaithongdi N, Subauste JS, Koch CA, Geraci SA. Diagnosis and management of hyperglycemic emergencies. Hormones (Athens). 2011 Oct-Dec; 10 (4):250-60.
Kitabchi AE, Umpierrez GE, Fisher JN, Murphy MB, Stentz FB. Thirty years of personal experience in hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state. J Clin Endocrinol Metab. 2008 May; 93 (5):1541-52.
Kitabchi AE, Murphy MB, Spencer J, Matteri R, Karas J. Is a priming dose of insulin necessary in a low-dose insulin protocol for the treatment of diabetic ketoacidosis? Diabetes Care. 2008 Nov; 31 (11):2081-5.
Umpierrez GE, Latif K, Stoever J, et al, Efficacy of subcutaneous insulin lispro versus continuous intravenous regular insulin for the treatment of patients with diabetic ketoacidosis. Am J Med 2004; 117: 291-296.
Della Manna T, Steinmetz L, Campos PR, et al, Subcutaneous use of a fast-acting insulin analog: An alternative treatment for pediatric patients with diabetic ketoacidosis. Diabetes Care 2005; 28: 1856-1861.
Feleke Y, Enquselassie F. An assessment of the health care system for diabetes in Addis Ababa. Ethiop. J Health dev. 2005; 19 (3): 203-210.
Gudina et al, Assessment of quality of care given to diabetic patients at Jimma University Specialized Hospital diabetes follow-up clinic, Jimma, Ethiopia, BMC Endocrine Disorders 2011.
Adem A, Demis T, Feleke Y. Trend of diabetic admissions in Tikur Anbessa and St. Paul’s University Teaching Hospitals from January 2005–December 2009, Addis Ababa, Ethiopia. Ethiop Med J. 2011; 49 (3):231–8.
Seblework Temsegen, Acute Management of Diabetic Ketoacidosis in Tikur Ambesa Hospital’s Adult Emergency department and medical wards, American International Health Alliance's, 2012.
Dawit Worku (MD), Leja Hamza (MD), Kifle Woldemichael (MD), patterns of diabetic complications at Jimma university specialized hospital, southwest Ethiopia, Ethiop J Health Sci. Vol. 20, No. 1 March 2010.
Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care 2009; Jul; 32 (7):1335-43.
Weissberg-Benchell J, Antisdel-Lomaglio J, Seshadri R. Insulin pump therapy: a meta-analysis. Diabetes Care 2003; 26: 1079–1087.
Peterson LN, Levi M. Disorder of potassium and metabolism. In: Schrier RW (ed). Renal and electrolyte disordes, 6th edn, Lippincott Williams & Wilkins, Philadelphia; 2002; pp, 171-215.
Calzavacca P, Lacari E, Bellomo R. In: Stewart's Textbook of Acid-Base. Ebers P, Kellum J Lulu.com, editor. 2009. Renal failure; pp. 394–395. Clinical applications of quantitative acid-base medicine.
Kraut JA, Kurtz I. Use of base in the treatment of severe acidemic states. American Journal of Kidney Diseases 2001; 38:703-727.
Eisenbarth GS, Polonsky KS, Buse JB 2008 Acute diabetic emergencies: Diabetic ketoacidosis. In: Kronenberg HM, Melmed S, Polonsky KS et al (eds). Williams Textbook of Endocrinology, 11th edn, Saunders Elsevier, Pennsylvania; pp, 1407-1416.
Geerse DA, Bindels AJ, Kuiper MA, et al, Treatment of hypophosphatemia in the intensive care unit: a review. Crit Care 2010; 14: R147.
Umpierrez GE, Jones S, Smiley D, Mulligan P, Keyler T, Temponi A, Semakula C, Umpierrez D, Peng L, Cero´n M, Robalino G. Insulin analogs versus human insulin in the treatment of patients with diabetic ketoacidosis: a randomized controlled trial. Diabetes Care. 2009 Jul; 32 (7):1164-9.
Arefi M, Tabrizchi N. Nalidixic acid and diabetic ketoacidosis. Indian J Endocrinol Metab. 2012 Mar; 16 Suppl 1:S124-6.
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186