Diabetic Ketoacidosis: Characteristics of Admission in Intensive Care

Introduction: Diabetic ketoacidosis (DK) is characterized by the presence of hyperglycemia associated with metabolic acidosis and increased concentration of ketone bodies. Despite its clinical severity, the associated mortality and hospitalization time are low. The aim of this study was to evaluate the clinical characteristics of patients admitted to Intensive Care Unit (ICU) by DK. Methods: Retrospective study on patients admitted to ICU between 2010 and 2017 with diagnosis of DK. We collected variables related to the previous history of diabetes mellitus (DM), characterization of DK and hospitalization in ICU. Results: A total of 53 patients were included, with 52.8% females and a mean age of 41.04 +/- 14.18 years. The majority had a diagnosis of type 1 DM (52.8%, n= 28). Regarding the treatment modalities. most patients were exclusively on insulin (67.9%, n= 36). Most patients, 73.6% (n= 39), were admitted for severe DK, 18.9% (n= 19) for moderate DK and 7.5% (n= 4) for mild DK. The most frequent reason for decompensation was therapeutic non-compliance (32.1%, n= 17). The median admission delay to ICU care was of 4 hours, and median ICU and hospital stays were of 2 and 6 days, respectively. Only 17% of patients (n= 9) were admitted to level 3C of intensive care. In what concerns the median severity scores at admission, we have obtained a SOFA of 1.0, APACHE II of 12, SAPS II of 27 and SAPS III of 42.5.There was a positive and statistically significant relationship between the number of days of hospitalization in ICU and the variables APACHE II, SAPS II, SAPS III and SOFA. Conclusion: The majority of the patients that enrolled in this study had type 1 DM and severe DK was the most common diagnosis. They had low severity indices, a rare need for invasive organ support techniques and short stay in ICU. The authors conclude that most of them were admitted to ICU not just because of clinical severity, but also because of the availability of a place with better conditions for monitoring and treatment.