Analysis of Diabetic Ketoacidosis and Hyperosmolar Nonketotic Coma Cases

ABSTRACT
In this retrospective study, diabetic ketosis (DK), ketoacidosis (DKA) and hyperosmolar nonketotic coma (HONC) cases were analysed in a 15 year period (1980-1995). File documents of patients admitted to Hacettepe University Hospital were evaluated. Based on the medical records, clinical history and laboratory features, patients were classified to have DK, DKA and HONC. Of 82 cases evaluated, 47 of them fulfilled the criteria for DKA, 23 cases for diabetic ketosis and the remaining 12 cases for HONC. Of 47 cases with DKA, 66% had juvenile onset (<30 years) type I diabetes, 14.9% had adult onset (>=30 years) type I diabetes and the remaining 19.1% had type II diabetes mellitus. Of patients with diabetic ketosis, 78% had type II, 13 % had juvenile onset, 4.3% had adult onset type I and 4.3% had secondary diabetes. All cases with HONC were diagnosed as having type II. Ketoacidosis was found as the initial clinical presentation in 13.4% of cases. In the whole group, the most common precipitating factor was infection (32.9%). Omission of insulin therapy (9.8%), trauma (4.9%), myocardial infarction (2%) and cerebrovascular accident (1%) were other precipitating factors. In 25.6% of patients, the cause of ketoacidosis was unknown. As to DKA cases, urinary tract infection in two patients (4.3 %), hypoglycemia in five patients (2.1%), thrombophlebitis in one patient (2.1%), acute renal failure in two patients (4.3%) and for diabetic ketosis cases, hypoglycemia in 4 patients(17.3%) and sepsis in 2 patients(8.7%) developed as a complication during the treatment.. In HONC cases, sepsis, brain edema, thrombophlebitis and mesenteric vascular disease were seen in one patient (8.3%) for each. Mortality rates for DKA, diabetic ketosis and HONC cases were 6.4%, 8.7% and 33.3% respectively. The data suggest that DKA and HONC are still major problems in diabetic patients despite the advance in diagnosis and treatment.