Characteristics of severe diabetic ketoacidoses occurring before and after 60 years of age.

Between 1978 and 1982, 459 cases of severe diabetic ketoacidosis (pH less than or equal to 7.20, total -CO2 less than or equal to 10 mMol/l) were admitted to our Intensive Care Unit. 416 (241 males, 175 females) were under 60 years (41 +/- 7) and 43 (22 males, 21 females) exceeded 60 years of age (67 +/- 7). The precipitating causes were fairly similar, in both groups, with infections foremost (68%). Presenting biochemical parameters, before and after 60 years showed differences in: blood glucose: 32.7 +/- 12 versus 34.8 +/- 8.1 mMol/l; plasma sodium 137 +/- 14 versus 143 +/- 16 mMol/l; plasma potassium 4.2 +/- 0.9 versus 4.9 +/- 0.7 mMol/l; hydrogen ion concentration 95 +/- 17 versus 73 +/- 12 mMol/l, (p less than 0.01); plasma osmolarity 327 +/- 98 versus 379 +/- 96 mOsm/l. The difference was significant (p less than 0.01) in frequency of hypernatremic hyperosmolarity (initial sodium greater than 147 mMol/l): 7.4% of 202 cases before age 60 years versus 24.1% of 29 case after age 60 years. The fluid amounts administered i.v. within the first 24 h was greater before (7516 +/- 2121 ml; p less than 0.01) than after 60 years (5276 +/- 1132 ml); insulin requirements were greater after 60 years (236 +/- 78 U/24 h; p less than 0.01) than before the age of 60 years (182 + 59 U/24 h). The mortality rate in the course of severe diabetic ketoacidoses was significantly lower before 60 years (1.3%, p less than 0.01) as against 6.9% after age 60 years.(ABSTRACT TRUNCATED AT 250 WORDS)