Lee Melissa H, Calder Genevieve L, Santamaria John D, MacIsaac Richard J
Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
Department of Intensive Care, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
Intern Med J. 2018 May;48(5):529-534. doi: 10.1111/imj.13735.
Diabetic ketoacidosis (DKA) is an acute life-threatening metabolic complication of diabetes that imposes substantial burden on our healthcare system. There is a paucity of published data in Australia assessing factors influencing time to resolution of DKA and length of stay (LOS).
To identify factors that predict a slower time to resolution of DKA in adults with diabetes.
Retrospective audit of patients admitted to St Vincent's Hospital Melbourne between 2010 to 2014 coded with a diagnosis of 'Diabetic Ketoacidosis'. The primary outcome was time to resolution of DKA based on normalisation of biochemical markers. Episodes of DKA within the wider Victorian hospital network were also explored.
Seventy-one patients met biochemical criteria for DKA; median age 31 years (26-45 years), 59% were male and 23% had newly diagnosed diabetes. Insulin omission was the most common precipitant (42%). Median time to resolution of DKA was 11 h (6.5-16.5 h). Individual factors associated with slower resolution of DKA were lower admission pH (P < 0.001) and higher admission serum potassium level (P = 0.03). Median LOS was 3 days (2-5 days), compared to a Victorian state-wide LOS of 2 days. Higher comorbidity scores were associated with longer LOS (P < 0.001).
Lower admission pH levels and higher admission serum potassium levels are independent predictors of slower time to resolution of DKA. This may assist to stratify patients with DKA using markers of severity to determine who may benefit from closer monitoring and to predict LOS.
糖尿病酮症酸中毒（DKA）是糖尿病一种危及生命的急性代谢并发症，给我们的医疗系统带来了沉重负担。澳大利亚公开的数据较少，缺乏对影响DKA缓解时间和住院时间（LOS）因素的评估。
确定预测糖尿病成年患者DKA缓解时间较慢的因素。
对2010年至2014年入住墨尔本圣文森特医院且诊断为“糖尿病酮症酸中毒”的患者进行回顾性审计。主要结局是基于生化指标正常化的DKA缓解时间。还对更广泛的维多利亚州医院网络内的DKA发作情况进行了探究。
71例患者符合DKA的生化标准；中位年龄31岁（26 - 45岁），59%为男性，23%为新诊断糖尿病患者。胰岛素停用是最常见的诱因（42%）。DKA缓解的中位时间为11小时（6.5 - 16.5小时）。与DKA缓解较慢相关的个体因素是入院时较低的pH值（P < 0.001）和较高的入院血清钾水平（P = 0.03）。中位住院时间为3天（2 - 5天），而维多利亚州全州的住院时间为2天。较高的合并症评分与较长的住院时间相关（P < 0.001）。
入院时较低的pH值水平和较高的入院血清钾水平是DKA缓解时间较慢的独立预测因素。这可能有助于使用严重程度标志物对DKA患者进行分层，以确定哪些患者可能从密切监测中获益并预测住院时间。
