Diabetic ketoacidosis: recurrence was fairly common.

Clinical bottom line (level 2c)

  1. The commonest causes of diabetic ketoacidosis were infection or errors in insulin dosing.
  2. Recurrence of diabetic ketoacidosis occurred in two-fifths of patients.
Johnson et al: Mayo Clinical Proc 1980; 55: 83-88
Expires October 2003

The study

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

Setting: town and surroundings, USA, 1924 to 1976

92 patients (aged range 4 to 83 years; median 42, 58% female) diabetic ketoacidosis (defined as hyperglycaemia, ketonaemia and plasma bicarbonate <15 mmol/l) with either type I and type II diabetes



Outcomes studied:
  • cause: infection
  • cause unknown
  • cause: insulin dosage omitted
  • cause: myocardial infarction
  • cause: congestive heart failure
  • other cause
  • no subsequent DKA episodes
  • one subsequent DKA episode
  • two subsequent DKA episodes
  • three or more subsequent DKA episodes

    • Population taken from a cohort of 1536 patients

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    cause: infection ? 29/92 32%
    (22% to 41%)
    cause unknown ? 17/92 19%
    (11% to 26%)
    cause: insulin dosage omitted ? 12/92 13%
    (6.2% to 20%)
    cause: myocardial infarction ? 6/92 6.5%
    (1.5% to 12%)
    cause: congestive heart failure ? 2/92 2.2%
    (0.0% to 5.2%)
    other cause ? 5/92 5.4%
    (0.8% to 10%)
    no subsequent DKA episodes ? 46/79 58%
    (47% to 69%)
    one subsequent DKA episode ? 18/79 23%
    (14% to 32%)
    two subsequent DKA episodes ? 8/79 10%
    (3.5% to 17%)
    three or more subsequent DKA episodes ? 7/79 8.9%
    (2.6% to 15%)

    • 14% (95% CI: 7.1% to 21%) died within 48 hours of admission.

    Comments

    1. This study covers 50 years, during which time huge changes in general health and management of serious disease have occurred. Consequently the applicability of these results to today's patient is less certain.

    Citation

    1. Johnson DD, Palumbo PJ, Chu C-P: Diabetic ketoacidosis in a community-based population. Mayo Clinical Proc 1980; 55: 83-88
    Search Terms: ketoacid* in Cochrane
    Contributor: Chris Ball and Clare Wotton, July 2000
    Reviewer: Tadao Okada

    Clinical Question.
    Patient DKA
    Intervention or Exposure prevalence
    Outcome recurrence and causes