Abstract:
Background: Diabetes Ketoacidosis (DKA) is a major complication of Diabetes Mellitus (DM)
with a likelihood of high mortality if not managed appropriately. It is diagnosed with a triad of
hyperglycemia, ketonemia and metabolic acidosis. Objectives: To describe the precipitating
factors, clinical presentation and outcomes of DKA among patients attending Moi Teaching and
Referral Hospital (MTRH). Methods: This prospective study involved 120 consecutively
recruited participants diagnosed with DKA. Participants were drawn from the Emergency
department and Diabetes Outpatient clinic and followed up in the wards and intensive care unit
(ICU) in MTRH for up to 10 days. Focused history and physical examination was done. Blood
sugar was measured daily; blood ketones and blood gases were measured on days 1,2,3 and 5.
Precipitating factors, presentation and outcomes were summarised as frequencies and their
corresponding percentages and presented in tables and charts. Results: The median age of
participants was 33 years (IQR 23, 44.5). Type 1 DM represented 63.3% and type 2 DM 34.2%
of the patients. The most common precipitating factors for DKA were; new onset undiagnosed
DM (37.5%), missed medication (36.7%) and infection (35.8%). The most common presentation
was dehydration (97.5%) with 49.2% of the patients having severe DKA while 22.5% had mild
DKA. Urine and blood ketones for diagnosis of DKA were present in 46.4% and 100% of
patients respectively. The median length of hospital stay was 6 days (IQR 5,7) with infection
being a significant determinant (aOR 2.63). The number of days taken for DKA to resolve
ranged from 1 to 5 days with a median period of 3 days (IQR 2,3). DKA in-hospital mortality
was 9.2% with new onset DM being a significant determinant (uOR 5.19). Conclusion: Some of
the identified DKA precipitants in the study are preventable. The impact of DKA in MTRH is
notable given the significant hospital stay and mortality. Recommendation: We recommend
implementation research studies that would develop and test different strategies to address the
precipitants to prevent DKA. For the hospital to undertake an audit of current DKA management
process with the aim of improving outcomes in terms of hospital stay and mortality.