Abstract
Study aimed to determine the rate and prediction of infection in diabetes mellitus patients ≥18 year, with diabetic ketoacidosis (DKA). Retrospective cohort study design was adopted to achieve the objectives. Universal sampling technique was employed for data collection among Diabetes ketoacidosis patients, over a period of 3 years (Jan 2008-Dec 2010). Statistical package for social sciences used to analyze data. Over a 3-year period, total of 967 admissions were identified. Of it, 112 (11.6%) with no infection, 679 (70.2%) with bacterial infection and 176 (18.2%) with presumed viral infection. The mean WBC for all the patients was 18,177 (±9431). 721 (74.6%) had leukocytosis, as defined by a WBC ≥ 15,000/mm3. WBC, differential, leukocytosis, as well as sex, temperature were not significant predictors (p > 0.05) of bacterial infection. There was significant (p < 0.05) difference of age between the 3 groups, age above 57 years have high rate of infection as compared to age below and equal 57 years. The infection rate in elderly patients with DKA was high and majority of them had lack of clinical evidence. Major bacterial infections with potential serious sequel were particularly common (33.3%), among every third patient being presumed to have serious consequences.
Highlights
It is commonly believed that acute infectious illness can precipitate episodes of ketoacidosis in patients with diabetes mellitus
A diligent search for bacterial infection is considered essential in the initial evaluation of patients with diabetes ketoacidosis (DKA)
DKA is the evidence of poor metabolic control and usually indicates an absolute or relative imbalance between the patient’s requirements and the treatment, DKA-related mortality is low among patients who received standardized treatment, which includes administration of insulin, correction of hydroelectrolytic disorders, and management of the triggering factor [3,4,5,6,7,8]
Summary
It is commonly believed that acute infectious illness can precipitate episodes of ketoacidosis in patients with diabetes mellitus. For this reason, a diligent search for bacterial infection is considered essential in the initial evaluation of patients with diabetes ketoacidosis (DKA). The sign and symptoms associated with the kedoacidotic state often make the search for potential infections quiet difficult. These patients often ill appearing, and may have nonspecific symptoms including malaise, headache, abdominal pain, vomiting and altered mental status [9]. The majority of adult studies have failed to show a clear association between the presence of leukocytosis and the existence of infections in the patient population [6,7]
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