Clinical profile of Libyan patients admitted with diabetic ketoacidosis

Abstract :

Diabetic ketoacidosis is a serious, medical emergency that can be fatal but treatable, we aimed to evaluate the clinical profile of patients admitted with diabetic ketoacidosis. This case series study enrolled 213 non-pregnant adult and adolescent patients admitted with diabetic ketoacidosis at Tripoli Diabetes Hospital from January to September 2023. Demographic data, clinical characteristics, laboratory findings, precipitating factors, and patient outcomes were extracted from medical records and analyzed. Type 1 diabetes mellitus was present in 187 (87.8%) of patients, the age range 11-84 years, (30.26±13.28), with 130 patients ≤ 30 years old (61.0%), females accounting for 110 of the patients (51.6%), 109 had a diabetes duration of less than 10 years (51.2%). The most common precipitating factor was insulin omission 92 (43.2%) in patients with known diabetes mellitus, whereas diabetic ketoacidosis as the first presentation of diabetes mellitus in 24 patients (11.7%), systolic blood pressure ranged 50-160 mmHg (112.82±16.19), diastolic blood pressure varied 30-100 mmHg (70.24±11.32). Plasma glucose at presentation ranged 183-1494 mg/dl (462.92±169.85), with Eu-glycemic diabetic ketoacidosis 100-249 mg/dl were in nine patients (4.2%), whereas most of cases (135 patients, 63.4%) present with plasma glucose 250-500 mg/dl, while hyperosmolar status (≥ 701 mg/dl) were present in 13 patients (6.1%). Venous pH varied from 6.7-7.42 (7.13±0.14), 132 (62.0%) patients presented with pH < 7.24, while severe acidosis was pH < 7 in 32 of patients (14.6%), serum bicarbonate with 10.93±4.95, severe (< 5 mmol) in 91 patients (42.7%) and moderate (5-10 mmol) were in 79 patients (37.08%). The mean length of hospital stay was 3.33 days, with an average of 2.11 days spent in the high-dependent unit. Serum potassium varied from 2.4-6.7 meq/L with 3.66± 0.63, most common complications of diabetic ketoacidosis treatment were hypokalemia observed in 82 (35.7%) of cases, and hypoglycemia was detected in 41 patients (19.2%). 170 patients were discharged in good condition (79.8%), and 17.8% of patients were transferred to another hospital to receive further management for co-morbid diseases with diabetes after controlling their hyperglycemic crises. The majority of patients presented with the critical status of diabetic ketoacidosis. The findings emphasize the importance of patient education about prevention measures prompt presentation to the hospital, and clinicians' awareness for early and aggressive treatment of hyperglycemic crises.

References

1. The Joint British Diabetes Societies (2023) The management of diabetic ketoacidosis in adults. Association British Clinical Diabetologists (ABCD) United Kingdom Clinical Pharmacy Association (UKCPA) Diabetes and Endocrinology Committee. Revised March 2023. Royal Free, London, UK.
2. Elmehdawi RR, Elmagerhei HM (2010) Profile of diabetic ketoacidosis at a teaching hospital in Benghazi, Libyan Arab Jamahiriya. Eastern Mediterranean Health Journal. 16 (3): 292-299. PMID: 20795443.
3. Elmehdawi RR, Ehmida M, Elmagrehi H, Alaysh A (2013) Incidence and mortality of diabetic ketoacidosis in Benghazi, Libya in 2007. Oman Medical Journal. 28 (3): 178-183. doi: 10.5001/omj.2013.50
4. Elkituni A, Elshwekh H, Bendala NM, Atwear WS, Aldaba FA, Fellah AM (2021) Profile of diabetic ketoacidosis at the National Diabetes and Endocrine Center in Tripoli, Libya, 2015. Diabetes and Metabolic Syndrome: Clinical Research and Reviews. 15 (3): 771-775. doi: 10.1016/j.dsx.2021.03.014
5. Elmiladi SA, Elgdhafi EO (2023) Prevalence of cardiovascular risk factors in Libyan patients with type 2 diabetes mellitus, 2013-2022. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 3 (2): 27-33. doi: 10.5281/ zenodo.7877416
6. Dhatariya KK, Umpierrez GE (2017) Guidelines for management of diabetic ketoacidosis: time to revise? The Lancet. Diabetes and Endocrinology. 5: 321-323. doi: 10.1016/S2213-8587(17)30093-1
7. Janssens B, Caerels S, Mathieu C (2020) SGLT inhibitors in type 1 diabetes: weighing efficacy and side effects. Therapeutic Advances in Endocrinology and Metabolism. 11: 2042018820938545. doi: 10.1177/20420188209 38545
8. Zhong VW, Juhaeri J, Mayer-Davis EJ (2018) Trends in hospital admission for diabetic ketoacidosis in adults with type 1 and type 2 diabetes in England, 1998-2013: A retrospective cohort study. Diabetes Care. 41 (9): 1870-1877. doi: 10.2337/dc17-1583
9. Dhatariya KK, Glaser NS, Codner E, Umpierrez GE (2020) Diabetic ketoacidosis. Nature Reviews Disease Primers. 6: 40. doi: 10.1038/s41572-020-0165-1
10. Lacy ME, Gilsanz P, Eng CW, Beeri MS, Karter AJ, Whitmer RA (2020) Recurrent diabetic ketoacidosis and cognitive function among older adults with type 1 diabetes: findings from the Study of Longevity in Diabetes. The BMJ Open Diabetes Research and Care. 8 (1): e001173. doi: 10.1136/bmjdrc-2020-001173
11. Cahill Jr GF (1970) Starvation in man. The New England Journal of Medicine. 282 (12): 668-675. doi: 10.1056/ NEJM197003192821209
12. Elmiladi S, Esabi L, Elhadi A, Elfoghi A, Salama Z (2015) Admission pattern of DKA at National Diabetes Hospital in Tripoli, Libya in 2015. Tripolitana Medical Journal. 4 (II): 56-63. doi: Nil.
13. Nunes RTL, Mota CFP, Gessolo Lins PRG, Reis FS, de Freitas Resende TC, de Andrade Barberino L, da Silva PHL, De Gois AFT (2021) Incidence, characteristics and long-term outcomes of patients with diabetic ketoacidosis: a prospective prognosis cohort study in an emergency department. Sao Paulo Medical Journal. 139 (1): 10-17. doi: 10.1590/1516-3180.2020.0285.R1.21102020
14. Misra S, Oliver N, Dornhorst A (2013) Diabetic ketoacidosis: not always due to type 1 diabetes. The British Medical Journal. 10: 346: f3501. doi: 10.1136/bmj.f3501
15. Benoit SR, Zhang Y, Geiss LS, Gregg EW, Albright A (2018) Trends in diabetic ketoacidosis hospitalizations and In-hospital mortality-United States, 2000-2014. Morbidity and Mortality Weekly Report. 67 (12): 362-365. doi: 10.15585/mmwr.mm6712a3
16. Adhikari PM, Mohammed N, Pereira P (1997) Changing profile of diabetic ketosis. Journal of Indian Medical Association. 95 (10): 540-542. PMID: 9567597.
17. Newton CA, Raskin P (2004) Diabetic ketoacidosis in type 1 and type 2 diabetes: Clinical and biochemical differences. Archives of Internal Medicine. 164 (17): 1925-1931. doi: 10.1001/archinte.164.17.1925
18. Yan SH, Sheu WH, Song YM, Tseng LN (2000) The occurrence of diabetic ketoacidosis in adults. Internal Medicine. 39 (1): 10-14. doi: 10.2169/internalmedicine.39.10
19. Faich GA, Fishbein HA, Ellis SE (1983) The epidemiology of diabetic acidosis: A population-based study. American Journal of Epidemiology. 117 (5): 551-558. doi: 10.1093/oxfordjournals.aje.a113577
20. Seth P, Kaur H, Kaur M (2015) Clinical profile of diabetic ketoacidosis: a prospective study in a tertiary care Hospital. Journal of Clinical Diagnostic Research. 9 (6): OC01-OC04. doi: 10.7860/JCDR/2015/8586.5995
21. Beigelman PM (1971) Severe diabetic ketoacidosis (diabetic “coma”). 482 episodes in 257 patients; experience of three years. Diabetes. 20 (7): 490-500. doi: 10.2337/diab.20.7.490
22. Pickup JC, Williams G (2002) Textbook of Diabetes. Wiley-Blackwell Sciences Publishing. 3rd Ed. Massachusetts, USA, 32. 1-33.19. ISBN-13: ‎978-0632059157.
23. Casteels K, Mathieu C (2003) Diabetic ketoacidosis. Reviews in Endocrine and Metabolic Disorders. 4 (2): 159-166. doi: 10.1023/a:1022942120000
24. Westphal SA (1996) The occurrence of diabetic ketoacidosis in non-insulin dependent diabetes and newly diagnosed diabetic adults. The American Journal Medicine. 101 (1): 19-24. doi: 10.1016/s0002-9343(96)00076-9
25. Umpierrez GE, Khajavi M, Kitabchi AE (1996) Review: diabetic ketoacidosis and hyperglycaemic hyperosmolar nonketotic syndrome. The American Journal of Medical Sciences. 311 (5): 225-233. doi: 10.1097/00000441-199605000-00006
26. Elmiladi SA (2023) GLP-1RA for glycaemic control and obesity as add-on therapy for type 2 diabetes. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 3 (2): 45-50. doi: 10.5281/zenodo.7942952

Citation :

Alfoghi et al. (2024) Clinical profile of Libyan patients admitted with diabetic ketoacidosis. Mediterr J Pharm Pharm Sci. 4 (2): 15-22. [Article Number: 154]. https://doi.org/10.5281/zenodo.11154992