Precipitating Factors and Clinical Presentation at the Time of Admission for Diabetic Ketoacidosis in Nangarhar Afghanistan

Abstract

The aim of the study was to determine the frequency of different DKA precipitating factors and the initial clinical feature at the time of admission. This descriptive prospective cross sectional study based on purposive sampling, was conducted in the medical ward of Nangarhar University Teaching Hospital from 28/12/2019 to 10/2/2021 including both female and male patients of any type of DM with DKA at the time of admission. After thorough history taking, physical examination and investigations such as lab, radiological and ECG, precipitating factors were found out.

All 72 patients had DKA. 52 (72.2%) patients were female and 20 (27.8%) were male. 11 patients (15.3%) were type 1 and 61 (84.7%) were type 2 DM. The median age of the patients was 50; median weight was 61; median systolic blood pressure 120 mmHg and the median FBS was 272 mg/dl at the time of admission. Nausea/vomiting (49, 68.1%), tachycardia (46, 63.9%), dry tongue (42, 58.3%), and epigastric tenderness (40, 55.6%), were the most frequent clinical presentation. Infection specifically UTI (68.1%) was the most frequent precipitating factor followed by IHD (11.1%) and insulin withdrawal (5.6%) respectively. UTI distribution across gender (52.8% vs 15.2% two sided P value 0.14 CI 0.95), DM type (58.33% T2DM vs 9.72% in T1DM out of 68% two sided P value 0.7 CI 0.95) and age category was different, however not significant due to the small sample size where the same story occurred with FBS difference across gender (two sided P value 0.035, CI 95%).

Infection especially UTI, ischemic heart disease and insulin withdrawal are the leading precipitating factors; and clinical presentation of gastrointestinal tract (nausea/vomiting), dehydration (dry tongue), cardiovascular system and urinary tract are the most prevalent in DKA patients at the time of admission in Nangarhar Afghanistan