Diabetic ketoacidosis: patients died from associated diseases.

Clinical bottom line (level 2c)

  1. Around 5% of patients with diabetic ketoacidosis and 15% of patients with hyperosmolar coma died.
  2. The commonest causes of death were pneumonia, myocardial infarction and bowel or leg ischaemia.
Hamblin et al: Medical Journal of Australia 1989; 151: 439-444
Expires October 2003

The study

Outcome study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, Australia, 1973-1988

. patients (aged mean 69 years, ?% male) with 528 episodes of diabetic ketoacidosis (with a pH 7.3 or less) and 82 episodes of hyperosmolar coma (osmolality 350 mOsmol/kg or more)
All patients received fluids and insulin; patients with severe acidosis (pH <7.0) had bicarbonate.


Outcomes studied:
  • total death
  • DKA death
  • hyperosmolar coma death
  • cause of death: pneumonia
  • cause of death: myocardial infarction
  • cause of death: bowel or lower limb ischaemia

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    total death ? 38/610 6.2%
    (4.3% to 8.2%)
    DKA death ? 26/528 4.9%
    (3.1% to 6.8%)
    hyperosmolar coma death ? 12/82 15%
    (7.0% to 22%)
    cause of death: pneumonia ? 12/38 32%
    (17% to 46%)
    cause of death: myocardial infarction ? 8/38 21%
    (8.1% to 34%)
    cause of death: bowel or lower limb ischaemia ? 6/38 16%
    (4.2% to 27%)

    • Patients with hyperosmolar coma were older than those with DKA- this may account for some of the increased mortality.
    • The mean length of hospital stay was 9 +/- 6 days.

    Citation

    1. Hamblin PS, Topliss DJ, Chosich N, et al: Deaths associated with diabetic ketoacidosis and hyperosmolar coma, 1973-1988. Medical Journal of Australia 1989; 151: 439-444
    Search Terms: reference in review article
    Contributor: Chris Ball and Clare Wotton, July 2000
    Reviewer: Jon Levine

    Clinical Question.
    Patient DKA
    Intervention or Exposure prevalence
    Outcome death, cause