Badipatla Kanthi Rekha, Jadhav Preeti, Vaddigiri Sushma, Bajantri Bharat, Singh Amandeep, Chandrala Chaitanya, Are Vijay S, Nayudu Suresh Kumar
Department of Medicine, Bronx Lebanon Hospital Center, Icahn School of Medicine at Mount Sinai, Bronx, New York, NY, USA.
Division of Gastroenterology, Bronx Lebanon Hospital Center, Icahn School of Medicine at Mount Sinai, Bronx, New York, NY, USA.
Gastroenterol Rep (Oxf). 2017 Nov;5(4):293-297. doi: 10.1093/gastro/gox006. Epub 2017 Apr 7.
Diabetic ketoacidosis (DKA) is a common acute complication of diabetes mellitus requiring aggressive medical management. We attempted to study the incidence and various clinical and laboratory variables associated with acute gastrointestinal bleeding (AGIB) and acute upper AGIB (AUGIB) in patients with DKA.
We conducted a retrospective chart review of all the patients admitted to our hospital with DKA between January 2010 and December 2015. We collected demographic, clinical, laboratory, endoscopy and hospitalization details using an electronic medical-record database. Patients were divided into two groups based on the occurrence of gastrointestinal bleeding.
A total of 234 patients with DKA were admitted during this period, of which 27 (11.5%) patients had documented AGIB. The majority of patients had hematemesis (=22, 9.4%) except two had rectal and three had occult bleeding. We did not notice any difference in age, gender and ethnicity distribution between the two groups. There was no difference in the serum levels of electrolytes, anion gap, pH and hemoglobin A1C between the two groups. However, patients with AGIB had significantly higher initial blood glucose levels (738 613 mg/dL, =0.014). There was also increased mortality (7.4% 4.8%) in patients with AGIB, but this did not reach statistical significance.
We conclude that higher initial serum blood glucose was associated with increased incidence of AGIB in patients admitted with DKA. We also noted increased in-patient mortality in patients with DKA who had AGIB, even though statistically insignificant. More aggressive measures to correct blood glucose levels may result in decreased incidence of AGIB, thereby reducing mortality during hospitalization in patients with DKA.
糖尿病酮症酸中毒（DKA）是糖尿病常见的急性并发症，需要积极的药物治疗。我们试图研究DKA患者急性胃肠道出血（AGIB）和急性上消化道出血（AUGIB）的发生率以及各种临床和实验室变量。
我们对2010年1月至2015年12月期间我院收治的所有DKA患者进行了回顾性病历审查。我们使用电子病历数据库收集了人口统计学、临床、实验室、内镜检查和住院细节。根据胃肠道出血的发生情况将患者分为两组。
在此期间，共有234例DKA患者入院，其中27例（11.5%）有AGIB记录。大多数患者有呕血（=22，9.4%），除2例有直肠出血和3例有隐匿性出血。我们没有注意到两组在年龄、性别和种族分布上有任何差异。两组之间的血清电解质水平、阴离子间隙、pH值和糖化血红蛋白A1C没有差异。然而，AGIB患者的初始血糖水平显著更高（738±613mg/dL，P=0.014）。AGIB患者的死亡率也有所增加（7.4%对4.8%），但这没有达到统计学意义。
我们得出结论，初始血清血糖较高与DKA入院患者AGIB发生率增加有关。我们还注意到发生AGIB的DKA患者住院死亡率增加，尽管在统计学上不显著。采取更积极的措施纠正血糖水平可能会降低AGIB的发生率，从而降低DKA患者住院期间的死亡率。
