Objective: To assess the incidences and outcomes of hyperglycemic crises.
Material and method: A retrospective study of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) in adults with type 1 or type 2 diabetes mellitus (DM) admitted to Thammasat Hospital between 2006 and 2010 was performed. Incidences, precipitating causes, clinical and laboratory characteristics, and treatment outcomes of hyperglycemic crises were obtained via medical record review Multivariate logistic regression analysis was used to determine predictors for mortality.
Results: Eighty-three patients were eligible and included. The mean age was 54.9 +/- 17.7 years old. Most subjects had type 2 DM (86.7%). The 5-year incidence of hyperglycemic crises was 7.46%. Diabetic ketoacidosis occurred more frequently than HHS (4.67% vs. 1.71%). During the hyperglycemic episodes, the mean plasma glucose level on admission was 741.3 +/- 320.8 mg/dL. Infections were the most common precipitating factor [61/83 (73.5%)], followed by non-compliance with treatments [35/83 (42.2%)]. Treatment complications included recurrent hyperglycemia (69.9%), hypokalemia (48.2%), hypernatremia (21.7%), and hypoglycemia (15.7%). The overall mortality rate of hyperglycemic crises was 8.4% (5.8% in DKA, 15.8% in HHS and 8.3% in the overlap of both conditions). The most common causes of death were infections [5/7 (71.4%)]. By multivariate analysis, serum sodium level on admission was independently associated with mortality (adjusted odds ratio 1.08, 95% CI 1.01-1.16, p = 0.03).
Conclusion: Hyperglycemic crises were common in the authors' setting. Diabetic ketoacidosis occurred more frequently but had a lower mortality rate than HHS. Complications from hyperglycemic crisis treatment could be prevented by close monitoring, while high serum sodium level on admission was a predictor for mortality. Strategies to prevent infections and improve treatment compliance are needed to reduce the incidence of hyperglycemic crises among patients with DM.