Diabetic ketoacidosis: clinical presentation and precipitating factors at Kenyatta National Hospital, Nairobi.
Diabetic ketoacidosis: clinical presentation and precipitating factors at Kenyatta National Hospital, Nairobi.
复制标题
糖尿病酮症酸中毒：内罗毕肯雅塔国家医院的临床表现和诱发因素。
DOI：
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发表时间：
2006
影响因子：
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通讯作者：
SO McLigeyo
中科院分区：
文献类型：
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作者：
C. Otieno;P. Mbugua;JK Kayima;A. Amayo;SO McLigeyo
目的
确定肯雅塔国立医院（KNH）糖尿病酮症酸中毒（DKA）的临床实验室特征和诱发因素。
设计
前瞻性横断面研究。
设置
KNH的住院内科和外科病房。
科目
年龄≥ 12岁的已知或既往未知糖尿病成人患者因糖尿病酮症酸中毒而住院。
结果
在9个月的时间内，在此期间住院的648名糖尿病患者中，有48名患者患有DKA，1名患者在全面评估前死亡。男性的平均（SD）年龄为37（18.12）岁，女性为29.9（14.3）岁，范围为12 - 77岁。一半的患者是新诊断的。超过90%的患者HbA 1c> 8%，只有3例患者HbA 1c为7- 8.0%。超过90%的患者意识水平改变，近四分之一处于昏迷状态，36%有收缩期低血压，近75%有中度至重度脱水。意识迟钝与严重脱水和代谢性酸中毒显著相关。超过65%的患者有白细胞增多，但大多数（55%）没有明显的感染。在诱发因素中，34%的人错过了胰岛素注射，23.4%的人有明显感染，只有6.4%的人既有感染又错过了胰岛素注射。感染部位包括呼吸道、泌尿生殖道和败血症。近30%（29.8%）的研究受试者在住院后48小时内死亡。
结论
约8%的住院糖尿病患者发生糖尿病酮症酸中毒。这是发病率和死亡率的一个主要原因。DKA的主要促发因素为感染和胰岛素注射遗漏。这些因素是可以预防的，以改善并发DKA的糖尿病患者的结局。
OBJECTIVE
To determine the clinico-laboratory features and precipitating factors of diabetic ketoacidosis (DKA) at Kenyatta National Hospital (KNH).
DESIGN
Prospective cross-sectional study.
SETTING
Inpatient medical and surgical wards of KNH.
SUBJECTS
Adult patients aged 12 years and above with known or previously unknown diabetes hospitalised with a diagnosis of diabetic ketoacidosis.
RESULTS
Over a nine month period, 48 patients had DKA out of 648 diabetic patients hospitalised within the period, one died before full evaluation. Mean (SD) age was 37 (18.12) years for males, 29.9 (14.3) for females, range of 12 to 77 years. Half of the patients were newly diagnosed. More than 90% had HbA1c > 8%, only three patients had HbA1c of 7-8.0%. More than 90% had altered level of consciousness, with almost quarter in coma, 36% had systolic hypotension, almost 75% had moderate to severe dehydration. Blunted level of consciousness was significantly associated with severe dehydration and metabolic acidosis. Over 65% patients had leucocytosis but most (55%) of them did not have overt infection. Amongst the precipitating factors, 34% had missed insulin, 23.4% had overt infection and only 6.4% had both infection and missed insulin injections. Infection sites included respiratory, genito-urinary and septicaemia. Almost thirty (29.8%) percent of the study subjects died within 48 hours of hospitalisation.
CONCLUSION
Diabetic ketoacidosis occurred in about 8% of the hospitalised diabetic patients. It was a major cause of morbidity and mortality. The main precipitant factors of DKA were infections and missed insulin injections. These factors are preventable in order to improve outcomes in the diabetic patients who complicate to DKA.