PROFILE OF DKA IN TYPE 2 PATIENTS IN SOUTHERN ANDHRA PRADESH – INDIA.

C.V.Harinarayan. Dept. of  Endocrinology & Metabolism, Sri Venkateswara Institute of Medical  Sciences, Tirupati.

One hundred and forty seven cases of diabetic ketoacidosis  (DKA) constituted 6.43% of the endocrine ward of the institute in a seven-year period.   Type 1 DM constituted 17.68% (n=26) of the cases and type 2 DM constituted 82.32% (n=121) of the cases.  All patients with type 1 DM and DKA survived.  Of the type 2 DM patients presenting with DKA 19% (n=23) expired.   The age at presentation in the recovered group and in the expired group were 67+ 4 and 55+ 14 years respectively.  The median age in both groups was 65 and 58 years respectively.   The M:F in both the groups was equal.  The average duration of stay in the recovered group was 10.5 + 7.9 days and expired group was 6.43 + 8.56 days.  The mean + SD of the biochemical parameters at the time of admission in those patients who recovered were as follows: Blood Shuare (mg%), urea (mg%), S.Creatinine (mg%), Na+(meq/l), K+(meq/l), HCO3(meq/l),pH, were 394±122; 62.5±35.6; 1.5±0.74; 132±9.4; 4.61±0.88; 14.68±9.56; 10.44±8.76; and in the expired group was 398±134; 58.5±53.2; 1.54±0.99; 128±1.4; 4.14±1.4; 14.53±7.18; 7.21±0.31.  There was no statistical difference in the biochemical values at recruitment between the NIDDM recovered Versus expired patients.

In the type 2-DM group that recovered, urine culture was positive in 13% and blood culture positive 4%.  Both urine and blood culture was positive in 2%.  Two patients had emphysematous pyelonephritis and renal abscess was found in one patient.  Both these patients recovered with appropriate therapy.  The precipitating events were that of macrovascular disease and its complications, septicemia, infections.  With adequaste treatment of the cause, the recovery is good in both the groups.