Oschatz E, Müllner M, Herkner H, Laggner A N
Department of Emergency Medicine, Vienna General Hospital-University of Vienna, Medical School, Austria.
Wien Klin Wochenschr. 1999 Aug 20;111(15):590-5.
Evaluation of prognostic factors of patients presenting with diabetic ketoacidosis (DKA) at an emergency department.
Retrospective cohort study.
The Emergency Department of the Vienna General Hospital, a 2000-bed tertiary care hospital.
Patients with DKA admitted from January 1, 1994 to September 30, 1998.
Treatment of DKA in accordance with a predefined regimen.
History, clinical findings, biochemical parameters, blood gas analysis, multiorgan failure score (MOF) and treatment modalities were assessed. Patients were followed until death or hospital discharge. For group comparison the Mann Whitney U-test was used. Within the study period 21 patients were admitted because of diabetic ketoacidosis (female: 10, median age: 42 years; 31 to 58). All patients suffered from insulin-dependent diabetes mellitus and were treated according to a standardised protocol. Six patients (29%) died in hospital. The non-survivors had significantly higher MOF-scores on admission (5 vs. 2, p < 0.001) and after 24 hours (4 vs. 0, p < 0.01) of intensive care treatment. Additionally, non-survivors had significantly higher levels of GOT (64 vs. 8 U/l), GPT (28 vs. 11 U/l), BUN (34.63 vs. 12.14 mmol/l), creatinine (291.7 vs. 150.3 mmol/l), amylase (315 vs. 78 U/l) and lipase (573 vs. 122 U/l) on admission than did survivors (p < 0.05), and also had a significantly higher net positive fluid balance after 24 hours (8.0 vs. 4.75 l, p < 0.05). All other parameters were not significantly different between the groups.
Multiple organ failure may develop in patients with diabetic ketoacidosis and is associated with poor prognosis.
