Objective: This study aims to identify predictors of 72-hour mortality in patients with diabetic ketoacidosis (DKA). Methodology: In this retrospective cohort study, data were obtained from medical records of adult patients with DKA in Cipto Mangunkusumo General Hospital from January 2011 to June 2017. Associations of predictors (age, type of diabetes, history of DKA, comorbidities, level of consciousness, renal function, bicarbonate, potassium, lactate, betahydroxybutyrate levels, and anion gap status) and 72-hour mortality were analyzed. The mortality prediction model was formulated by dividing the coefficient B by the standard error for all variables with p<0.05 in the multivariate analysis. Results: Eighty-six of 301 patients did not survive 72 hours after hospital admission. Comorbidities (HR 2.407; 95% CI 1.181–4.907), level of consciousness (HR 10.345; 95% CI 4.860–22.019), history of DKA (HR 2.126; 95% CI 1.308–3.457), and lactate level (HR 5.585; 95% CI 2.966–10.519) were significant predictors from multivariate analysis and were submitted to the prediction model. The prediction model had good performance. Patients with total score less than 3 points were at 15.41 % risk of mortality, 3 – 4 points were 78.01% and 5 – 6 points were 98.22% risk of mortality. Conclusion The 72-hour mortality rate in Cipto Mangunkusumo General Hospital was 28.57%. The mortality prediction model had a good performance and consisted of comorbidities, history of DKA, level of consciousness and lactate level.
Mortality ; Diabetic Ketoacidosis

Objective: This is a health systems research conducted with the goal of evaluating the quality of care (QoC) in diabetic emergencies, specifically Diabetic Ketoacidosis (DKA) and Hyperglycemic hyperosmolar state (HHS), at the Philippine General Hospital (PGH) in terms of structures, processes and outcomes, and determining facilitators and barriers to effective delivery of care from the healthcare providers’ point of view. Methods: The first phase of this study is a retrospective chart review involving an audit of the quality of services rendered to patients diagnosed to have DKA/HHS at the PGH. The second phase is a series of focus group discussions (FGDs) among physicians and nurses involved in the care of DKA/HHS patients. Facilitators and barriers to delivery of care were identified in these FGDs, as well as recommendations on how to improve delivery of care. Results: The recognition of DKA/HHS as a possible diagnosis at first encounter was observed in only 67% of cases. Timely initiation of hydration was met in 40% of cases and only 10% of the patients underwent adequate laboratory monitoring. Correction of at least half of the estimated water deficit in the first 24 hours of admission was achieved in 84% of the cases. Despite this, mortality rate was still high at 23%. Among those who died, thirty-seven percent (37%), seventy-five percent (75%) and over thirty percent (31%) had delayed initiation of hydration, at least one episode of hypokalemia or hypoglycemia, respectively. Barriers to good quality of care for DKA/HHS were mostly attributed to delays. These delays were due to lack of resources, limited bed-capacity and challenges experienced in the handling of specimen from the ER clerk to the laboratory and release of results. Conclusion Failure to follow guidelines and delays in the delivery of care are possible reasons for the high mortality rates noted and could be a reflection of poor quality of care among DM emergency patients in PGH. Proper documentation in the medical charts is also important. Clinical pathways and DM emergency kits are a few of the suggested approach to address the barriers to good quality care.
Diabetic Ketoacidosis ; Quality of Health Care

The occurrence of hyperuricemia is frequently associated with diabetic ketoacidosis (DKA), however, crystalluria from the precipitation of calcium oxalate, uric acid, or urate crystals, is less known. Metabolic derangements during DKA, especially acidic urinary pH and hyperuricosuria are the main risk factors for uric acid crystals and stones. Here we report a case of uric acid crystalluria following the recovery phase of DKA.
Crystalluria ; Uric Acid ; Diabetic Ketoacidosis

No abstract available.
Diabetic Ketoacidosis* ; Lung Abscess* ; Lung* ; Mucormycosis*

BACKGROUND: The aim of the study was to classify newly diagnosed diabetic patients who initially presented with diabetic ketoacidosis (DKA) into specific types of diabetes and to describe the clinical and biochemical characteristics of patients with fulminant type 1 DM in Korea. METHODS: Using data from 4 hospitals of CMC from 1 January 1999 to 1 March 2008, we identified all patients who manifested DKA when they were first diagnosed as diabetes. Clinical and laboratory data were reviewed from medical records. RESULTS: We identified 51 newly diagnosed diabetic patients manifested DKA. Among them, 14 (27.4%) patients were classified as autoimmune type 1 DM, 8 (15.7%) as antibody negative type 1 DM, 5 (9.8%) as fulminant type 1, 16 (31.4%) as type 2 DM and 8 (15.7%) as secondary DM. Five patients who fulfilled the criteria of fulminant type 1 DM were older (32.2 +/- 10.7 vs. 15.7 +/- 4.4 years, P = 0.010), had shorter duration of symptoms (4.2 +/- 2.7 vs.16.7 +/- 15.2 days, P = 0.014) and lower stimulated C-peptide levels (0.1 +/- 0.0 vs. 0.7 +/- 0.6 ng/mL, P = 0.050) compared with patients with autoimmune type 1 DM. CONCLUSION Newly diagnosed diabetic patients presenting with DKA composed of heterogenous types of diabetes. The prevalence of fulminant type 1 diabetes among them was 9.8% and the clinical and biochemical characteristics of these patients were different from those of autoimmune type 1 DM.
C-Peptide ; Diabetic Ketoacidosis ; Humans ; Korea ; Prevalence

Diabetic Ketoacidosis ; Humans ; Infant, Newborn ; Male

No abstract available.
Diabetic Ketoacidosis* ; Humans ; Mediastinal Emphysema* ; Vomiting*

Objective: This study aims to characterize the presentation, biochemical status of children with T1DM at diagnosis, the type of subcutaneous insulin regimens initiated, and to determine the incidence of T1DM in Bruneian children aged 18 years and younger. Methodology: A retrospective electronic and paper medical chart review was performed on patients aged 18 years and younger diagnosed with T1DM from 2013 to 2018 in Brunei Darussalam. Results: A total of 31 children with a mean age of 10.2 ± 3.6 years old were diagnosed with T1DM, of which 66.7% presented with diabetic ketoacidosis (DKA), a majority in severe DKA with an intercurrent illness (p=0.021). The mean HbA1c was 13.6 ± 2.7% with a mean serum glucose of 37.0±14.9 mmol/L at diagnosis. In the majority of the children (67.7%), multiple daily injections of subcutaneous insulin were initiated. The incidence of T1DM in children aged 18 years and younger was 4.9 per 100,000 for the year 2018. Conclusions The majority of the patients in this study presented with severe DKA with an intercurrent illness. This highlights the importance of childhood T1DM awareness among the public and healthcare providers. The incidence of childhood T1DM in Brunei Darussalam is similar to other countries in the Asian region, being relatively low, compared to the rest of the world.
Diabetes Mellitus, Type 1 ; Diabetic Ketoacidosis

Objectives: This study aims to determine the effect of the COVID-19 pandemic on the incidence, severity, and outcome of children diagnosed with diabetic ketoacidosis admitted in a tertiary pediatric hospital. Materials and Methods: Two groups were identified as the basis for classification: pre-pandemic (2017 to 2019) and COVID-19 pandemic (2020 to 2022). The Mann‐Whitney U test was utilized to test for the differences in continuous variables, while Pearson’s chi‐squared test was used to test for differences in categorical variables. Results: The study involved 136 participants, 63 of whom were recorded in the pre-pandemic period and 73 during the COVID-19 pandemic period. Data revealed no conclusive relationship between sex (p=0.578), age (p=0.225), or height (p=0.876) across the two time frames. However, data showed significant difference between the weight (p=0.007) and BMI (p=0.003) of children with DKA pre-pandemic and during pandemic. This implies that marked changes in weight and BMI reflect possible changes in health behaviors, healthcare access, or other variables that may have altered during the COVID-19 pandemic. Furthermore, there was no discernible difference between pre-pandemic and COVID-19 in terms of severity, incidence, or the amount of time between the onset of symptoms and consultation. Conclusion The demographic and clinical characteristics of patients with DKA across the two study periods indicate a degree of stability in patient profiles. Despite the unique circumstances of the pandemic, patient outcomes in terms of glycemic control and mortality were like those observed pre-pandemic. The significant difference in weight and BMI emphasizes how crucial it is to monitor and respond to modifications in the nutritional status and metabolic health of DKA patients during times of crisis, like the COVID-19 pandemic. Comprehending these changes can provide focused treatments aimed at promoting the best possible health outcomes for susceptible patient groups.
Diabetic Ketoacidosis ; Diabetes Mellitus ; COVID-19

No abstract available.
Acidosis* ; Adrenal Insufficiency* ; Child* ; Diabetic Ketoacidosis* ; Emergencies* ; Humans ; Hypocalcemia* ; Hypoglycemia*