What is Diabetic Ketoacidosis?
Diabetic ketoacidosis (DKA) is a medical condition that occurs when a person with diabetes has high blood glucose values. Generally, blood glucose needs to be elevated for a long period of time for ketones to begin to appear in the urine, but this time varies from person to person and from situation to situation. Insulin is required for the body to get energy from its preferred source, carbohydrates. Without enough insulin, the body burns fat, and this produces waste products called ketones. These ketones have a low pH and make the blood more acidic.
Immune responses such as illness or allergies, insulin pump malfunctions and too little insulin in the body can all lead to DKA. Statistics on the management of diabetes ketoacidosis relate to reasons for hospital entry, length of hospital stay and statistics about the patients themselves.
A person with diabetic ketoacidosis generally suffers from the symptoms of high blood glucose. These include intense thirst, a need to urinate and fatigue. The person with ketoacidosis may also have an odd smell on the breath that is often likened to that of nail polish remover. DKA can also be accompanied by abdominal pain, a rapid and weak pulse and labored breathing. The presence of diabetic ketoacidosis can be confirmed through a ketone test that shows high levels of ketones in the urine. DKA is considered to be a medical emergency.
Profile: Who Gets Diabetic Ketoacidosis?
Statistics on the management of diabetes ketoacidosis show that DKA affects males and females equally. In the past, women were hospitalized for DKA more often than men, but the situation is now changing. The very young and the very old are more likely to experience DKA.
Minority racial groups tend to be more affected by DKA than majority groups. In the United States in 1996, a study compared the death rates of African-American men and Caucasian men and found that the death rate of African-American men from DKA was 36.8 per 100,000 diabetics compared to 22.7 deaths in the group of Caucasian male diabetics.
Seizures and cerebral edema are two of the more serious complications of DKA. Cerebral edema occurs more often in children, occurring in 0.7 to 1 percent of children who present in DKA. These children may have a headache and be lethargic, and on an MRI it may show that they have dilated ventricles. Patients who suffer seizures during DKA have a mortality rate of around 70 percent.
In 20 to 30 percent of cases, DKA is the first sign of diabetes. This is an important statistic for front-line medical care professionals, since DKA is a life-threatening condition and correct and timely diagnosis can save lives.
In 2005, the death rate from all hyperglycemic crises was 0.8 per 100,000 of the general population. This is half the death rate in 1980. In those with diabetes, the death rate for DKA is gradually declining and the mortality rate for DKA is now less than 20 people out of 100,000 individuals with diabetes per year.
Length of Hospital Stay
Statistics on the management of diabetes ketoacidosis show a gradually shorter length of hospital stay over the decades. For those with diabetes as the first diagnosis on their hospital charts, the average length of stay has dropped in the last 30 years from a stay of 7.9 to 3.6 days. Friere’s 2002 study found that those adults who were admitted to the hospital for insulin noncompliance had a shorter average hospital stay of 2.8 days +/- 1 day than did those who were admitted due to an underlying illness. Those with an illness tended to stay in hospital for and average of 4.8 +/- 1 days.
Centers for Disease Control and Prevention. Average Length of Stay (LOS) in Days of Hospital Discharges with Diabetic Ketoacidosis as First-Listed Diagnosis, United States, 1980–2005. https://www.cdc.gov/diabetes/statistics/dkafirst/fig2.htm
Centers for Disease Control and Prevention. Age-Adjusted Death Rates for Diabetic Hyperglycemic Crises as Underlying Cause per 100,000 General Population, United States, 1980–2005. https://www.cdc.gov/diabetes/statistics/mortalitydka/fRateDKAGenAgeAdjusted.htm
Ennis, Elizabeth D., Robert A. Kreisberg. Diabetic Ketoacidosis and the Hyperglycemic Hyperosmolar Syndrome. In Diabetes Mellitus: A Fundamental and Clinical Text, 3rd Edition. https://www.msdlatinamerica.com/diabetes/sid845006.html
Freire AX, Umpierrez GE, Afessa B, Latif KA, Bridges L, Kitabchi AE. Predictors of intensive care unit and hospital length of stay in diabetic ketoacidosis. J Crit Care. 2002 Dec;17(4):207-11. https://www.ncbi.nlm.nih.gov/pubmed/12501147
Trachtenbarg, David E. 2005. Diabetic Ketoacidosis. American Family Physician.
Fishbein, Howard and PJ Palumbo. Acute Metabolic Complications in Diabetes. https://diabetes.niddk.nih.gov/DM/pubs/america/pdf/chapter13.pdf