Diabetic Emergencies: Experience of a Tertiary Endocrine Center | Stephy Publishers

 


SOJ Diabetes and Endocrinology Care - (SOJDEC)| Stephy Publishers


Abstract

Purpose: In this study, we aimed to retrospectively evaluate the demographic data, clinical features, laboratory data, precipitating causes of diabetic emergencies, complications in the follow-up of adult patients who applied to our hospital due to diabetic emergencies.

Methods: The study included patients aged 18 years and older referred to a tertiary endocrine center with diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS) hypoglycemia between January 2010 and May 2018.

Results: The study was carried out with 165patients, 69(41.8%) males, and 96(58.2%) females. The mean age of the patients was 43.8±20.4(18- 88). Of these patients, 77% (n=127) had DKA, 17% (n=28) had HHS and 6% (n=10) had hypoglycemia. Of the patients 55.2% (n=91) were type 1 DM, 44.8% (n=74) were type 2DM. When the precipitating causes of diabetic emergencies were examined, 32.7%(n=54) poor adherence to treatment and 32.1%(n=53) infection of the patients were involved. The new diagnosis was DM in 10.9% of the patients (n=18). The most common complication after treatment was hypopotassemia with 38.7% (n=60), but no complication was observed in the majority of patients (54.8%). In our study, total mortality was 1.8% and 11.1% in HHS patients. No mortality was found in DKA and hypoglycemia patients.

Conclusion: Diabetic ketoacidosis is more common in DM patients than in other diabetic emergencies. Approximately 11% of patients do not have a known diagnosis of diabetes. Poor adherence to treatment and infection are the most important precipitating causes of the diabetic emergency. The mortality rate is very low with early diagnosis and correct treatment.

Keywords

Diabetic emergencies, Diabetic ketoacidosis, Hyperosmolar hyperglycemic state, Hypoglycemia

Introduction

Diabetic emergencies include Diabetic ketoacidosis(DKA), Hyperosmolar Hyperglycemic State(HHS), and hypoglycemia. The common features of these diseases are their high mortality rates and being the most common reason for diabetic patients to apply to the emergency department.1 In addition to mortality risks, diabetic emergencies are also important with their high cost.2 DKA, HHS and hypoglycemia are serious complications of DM that require rapid diagnosis and treatment. DKA, and HHS are characterized by hyperglycemia and insulinopenia.3 Clinically, these two conditions differ only with the degree of dehydration and the severity of metabolic acidosis. The total mortality of DKA in society is below 1%. The mortality rate in patients with HHS is approximately 10 times higher than that associated with DKA. The prognosis in these patients is proportional to the severity of dehydration, the presence of co-morbid diseases, and age.4,5

Hypoglycemia was defined as a blood glucose level of 70mg/dl and below. Hypoglycemia classification was made according to the Ademolus Hypoglycemia Classification (ACH). (Grade 1-Mild hypoglycemia glucose 55-70mg/dl, grade 2-moderate hypoglycemia glucose 40-54mg/dl, grade-3 severe hypoglycemia glucose 10-39 mg/dl, grade-4 very severe hypoglycemia glucose<10mg/dl).6 The aim of this study was to retrospectively evaluate the demographic data, clinical characteristics, laboratory data, precipitating factors causing diabetic emergencies, complications during follow-up, and recovery times of patients followed up in a tertiary endocrine center for diabetic emergencies.


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