Tabenda Bashir, Jamal Zafar, Muhammad Sharif, Rizwan Aziz Qazi, Shajee Siddiqui, Saima Ambreen, Marium Mehboob, Abdul Rehman Faisal.
Diabetes ketoacidosis: clinical presentations and precipitating factors.
J Pak Inst Med Sci Jan ;15(1):857-61.

In this prospective study, patients with DKA admitted to Pakistan Institute of Medical Sciences, Islamabad were studied with aims to identify various modes of presentation & various precipitating factors of DKA. Out of the 50 patients studied, 27 were males & 23 females. The mean age at presentation was 40 years (range 13-70 years). Twenty (40%) patients were type I & thirty (60%) type II diabetics. Only five (10%) patients had previous history of DKA & five (10%) had DKA as the first manifestation of diabetes. A detailed history and a thorough examination were undertaken with a particular stress on the signs of dehydration, Kussmaul breathing, acetone odor & the level of consciousness. Biochemical measurements included measurement of blood sugar, serum ketones, ABGs, serum electrolytes & serum osmolality. The common presenting features were gastrointestinal disturbance, nausea & vomiting (76%), abdominal pain (52%), polyuria & polydipsia (58%), signs of dehydration with low blood pressure & tachycardia (46%), altered level of consciousness ranging from drowsiness to comatose state (68%) and acetone odor & Kussmaul breathing (78%). Main precipitating factor was infection (40%) and failure to take prescribed dose of insulin when they were sick because of various factors. A low mortality rate of 4% compared favorably with other studies.

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