Assessment of clinical Pattern, precipitating factors and outcome of Diabetic Keto-acidosis among patients visiting Adult Emergency at Saint Paul’s Hospital Millennium Medical College

Abstract

Abstract Background: Diabetic keto-acidosis (DKA) was one of the most acute complications of diabetes mellitus. The mortality rate of DKA was higher in developing countries. Diabetes mellitus has life threatening complications which is precipitated by various factors such as infections, trauma, cardiovascular diseases and pregnancy. There was lack of data regarding the clinical pattern, precipitating factors and outcome of DKA at the current study setting. Objective: The aim of this study was to assess the clinical pattern, precipitating factors and outcome of DKA among patients presented to the adult emergency department at St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia, from January 1st, 2019 to December 31st, 2021. Methods: Hospital-based cross sectional descriptive chart review at St. Paul's Hospital Millennium Medical College. Diabetic keto-acidosis patients who were admitted from January1st 2019 to December31st 2021 were included. Sample size was estimated using single population proportion formula. Data were analyzed using SPSS version 25. Descriptive analysis and bivariable multiple regression analyses were used. Statistical significance was considered for variables with p < 0.05. Results: A total of 261 medical charts of diabetic patients with DKA were reviewed. Patients’ median (interquartile range) age was 35 (26–46) years, with male predominance (62.1%). Polydipsia and polyuria were the most frequent presenting symptoms. About 39.1% of diabetes was first time presentation with DKA while infection and insulin discontinuation were the most common precipitating factors. Sixty-four (24.5%) the patients had bad management outcome, with mortality rate of (1.5%). Having moderate and severe DKA [AOR=5.40 (95%CI:(2.51,11.62)] and having a lower GCS score at presentation [AOR=3.49 (95%CI: (1.11,10.99)] were significantly associated with bad management outcome. Conclusion: Polydipsia and polyuria were the most frequent presenting symptoms. One fourth of DKA patients had bad management outcome. Due focus should be given to raise the awareness of the general public about precipitating factors and overall comprehensive diabetic care. Keywords; Diabetic ketoacidosis, clinical pattern, precipitating factors, management outcome, Ethiopia.