Table 2.
Characteristics of DKA episodes stratified by severity.
| Total episodes (N =54) | Mild (N=33) | Moderate (N=17) | Severe (N=4) | |
|---|---|---|---|---|
| Biochemistry at presentation | ||||
| Acid base | ||||
| pH | 7.27 (7.16-7.30) | 7.29 (7.28-7.3) | 7.14 (7.13-7.22) | 6.90 (6.91-6.93) |
| HCO3- (mmol/l) | 10.06 ± 4.15 | 12.33 ± 2.69 | 7.59 ± 3.15 | 2.4 ± 1.7 |
| Base excess(mmol/l) | 14.8 (12.0-18.9) | 13.4 (10.0-15.0) | 20.5 (16.3-23.5) | 26 (25-27) |
| Lactate(mmol/l) | 1.1 (0.7-1.5) | 1 (0.7-1.35) | 1.3 (1.1-2.3) | 1.3 (1.2-2.8) |
| Glycemic status and control | ||||
| Blood glucose (mmol/l) | 19.0 ± 5.1 | 18.3 ± 4.6 | 19.4 ± 5.6 | 23.4 ± 4.7 |
| HbA1c (%) | 9.2 (7.7-11.3) | 9.8 (7.7-11.3) | 8.8 (6.9-11.2) | 8.9 (8.5-11.6) |
| HbA1c (mmol/mol) | 77 (61-100) | 84 (61-100) | 73 (52-99) | 74 (69-103) |
| Potassium on presentation (mmol/l) | 4.1 (3.6-4.5) | 3.8 (3.4-4.4) | 4.3 (4.2-4.6) | 4.5 (4.0-5.9) |
| Hypokalemia (K<3.5mmol/l) n(%) | 7 (13%) | |||
| Infective markers | ||||
| C-reactive protein mg/l | 5 (25-94) | 24 (6-172) | 42 (6-89) | 22 (5-68) |
| Gestation at DKA event n=54 (weeks) | 29 (26-32) | 29 (23-32) | 31 (27-35) | 26 (11-27) |
| Precipitant* n(%) | ||||
| More than one precipitant per DKA episode | 2 (4%) | 1(3%) | 0 | 1 (25%) |
| Infection n(%) | 14 (26%) | 9 (27%) | 3 (18%) | 2 (50%)$ |
| Urinary tract infection n(%)** | 11/14 (79%) | 9/9 (100%) | 2/3 (67%) | 0 |
| Insulin discontinued n(%) | 14 (26%) | 9 (27%) | 2 (12%) | 3 (75%) |
| Betamethasone n(%) | 11 (20%) | 7 (21%) | 4 (24%) | 0 |
| Vomiting n(%) | 3 (6%) | 2 (6%) | 1 (6%) | 0 |
| No precipitant identified n(%) | 12(22%) | 5(18%) | 7(41%) | 0 |
| Adverse event in first 24-hours after insulin initiation | ||||
| Hypokalemia (K<3.5mmol/l) n(%) | 35 (65%) | 20 (61%) | 12 (71%) | 3 (75%) |
| Hypoglycemia (<4.0mmol/l) n(%) | 28 (52%) | 18 (55%) | 7 (41%) | 3 (75%) |
| >1 episode of hypoglycemia n(%) | 14 (26%) | 8 (24%) | 5 (29%) | 1 (25%) |
| Hypoglycemia and hypokalemia n(%) | 17 (31%) | 9 (27%) | 5 (29%) | 3 (75%) |
| Management | ||||
| Total length of hospital stay (days) | 7.5 (6.0-11.0) | 7.0 (5.5-11.0) | 8.0 (6.0-12.0) | 8.5 (5.8-11.3) |
| Length of stay in OCCU (days) | 3 (2-4) | 3 (2-4) | 3 (3-5) | 4.5 (2.5-5) |
| Resolution of individual parameters of event in hours | ||||
| pH >7.30 (hrs) | 15.5 ± 10.9 | 12.9 ± 11.6 | 19.1 ± 8.8 | 21.3 ± 8.9 |
| HC03- >15 mmol/l (hrs) | 25.7 ± 16.0 | 20.8 ± 16.3 | 33.1 ± 13.6 | 32.0 ± 10.8 |
| Glucose <12 mmol/l (hrs) | 5.4 ± 3.9 | 4.7 ± 2.8 | 6.5 ± 5.6 | 6.3 ± 1.3 |
| IV fluid* administered (ml/24hrs) | 4126 ± 1258 | 4040 ± 1188 | 4142 ± 1436 | 4765 ± 1137 |
| Potassium administered (mmol/24hours) | 80 (40-120) | 40 (25-80) | 90 (80-120) | 120 (80-120) |
| Insulin (IU/24hrs) | 68 (42-114) | 66 (41-91) | 112 (48-125) | 94 (66-129) |
OCCU, obstetric critical care unit; *includes DKA events where more than one precipitant occurred **urinary tract infections expressed as percentage of total number of infections recorded as precipitants.
$Two different infections occurred in a single patient.