Diabetic ketoacidosis: around 10% died and 5% had another episode

Clinical bottom line (level 4)

  1. Around one in sixty diabetic patients admitted to hospital had diabetic ketoacidosis.
  2. Roughly 10% were admitted in a coma, and roughly 10% die.
  3. Around 5% had another admission with DKA.
Faich et al: American Journal of Epidemiology 1983; 117 (5): 551-558
Expires January 2004

The study

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

Setting: 15 acute hospitals, USA; over 1 year

137 patients (aged mean 43, 64% female) with diabetic ketoacidosis (defined as first recorded blood sugar >300 mg/dl, first recorded bicarbonate <15 meq/dl)

Excluded if
  • concurrent pulmonary diagnosis and pH not done
  • arterial pH > 7.3 within first 24 hours
  • diagnosis of chronic renal failure




    • ? followed for discharge
    Outcomes studied:
  • admission with diabetic ketoacidosis out of total diabetic admissions
  • admitted in a coma
  • death
  • multiple admissions with DKA

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    admission with diabetic ketoacidosis discharge 152/9663 1.6%
    (1.4% to 1.9%)
    admitted in a coma discharge 15/137 11%
    (5.7% to 16%)
    death discharge 13/137 9.5%
    (4.6% to 14%)
    multiple admissions with DKA discharge 8/137 5.8%
    (1.9% to 9.8%)

    Comments

    1. The commonest causes of DKA were infection and non-compliance.

    Citation

    1. Faich GA, Fishbein HA, Ellis SE: the epidemiology of diabetic acidosis: a population-based study. American Journal of Epidemiology 1983; 117 (5): 551-558
    Contributor: Chris Ball and Clare Wotton, Unknown Month 1999
    Reviewer: William Rhoton

    Clinical Question.
    Patient diabetes
    Intervention or Exposure diabetic ketoacidosis
    Outcome death, readmission