Table.
Clinical and biochemical characteristics
| All cases (n=35) | DKA (n=11) | Mixed DKA and HHS (n=13) | Hyperglycaemic ketosis (n=9) | HHS (n=2) | ||
|---|---|---|---|---|---|---|
| Demographic and anthropometric parameters | ||||||
| Sex | ||||||
| Male | 77·1% (27) | 63·6% (7) | 23·1% (3) | 44·4% (4) | 0% (0) | |
| Female | 22·9% (8) | 36·4% (4) | 76·9% (10) | 55·6% (5) | 0% (0) | |
| Age (years) | 60 (45 to 70) | 57 (48 to 64) | 54 (42 to 85) | 63 (36 to 77) | 69 (65 to 72) | |
| BMI (kg/m2) | 23·5 (20·7 to 27·3) | 24·7 (21·3 to 28·5) | 22·7 (22·2 to 27·9) | 26·0 (23·6 to 27·4) | 25·4 (21·9 to 27·6) | |
| Ethnicity | ||||||
| African | 40·0% (14) | 45·4% (5) | 30·7% (4) | 33·3% (3) | 100% (2) | |
| Afro-Caribbean | 8·6% (3) | 0% (0) | 15·4% (2) | 11·1% (1) | 0% (0) | |
| Asian—Chinese | 5·7% (2) | 9·1% (1) | 7·7% (1) | 0% (0) | 0% (0) | |
| Asian—Indian | 8·6% (3) | 0% (0) | 7·7% (1) | 22·2% (2) | 0% (0) | |
| Caucasian | 20·0% (7) | 27·3% (3) | 23·1% (3) | 11·1% (1) | 0% (0) | |
| Mixed | 17·1% (6) | 18·2% (2) | 15·4% (2) | 22·2% (2) | 0% (0) | |
| Medical background | ||||||
| Type of diabetes | ||||||
| Type 1 | 14·3% (5) | 18·2% (2) | 15·4% (2) | 11·1% (1) | 0% (0) | |
| Type 2 | 80·0% (28) | 81·8% (9) | 76·9% (10) | 88·9% (8) | 50·0% (1) | |
| New presentation | 5·7% (2) | 0% (0) | 7·6% (1) | 0% (0) | 50·0% (1) | |
| ARB or ACE inhibitor | 40·0% (14) | 27·3% (3) | 53·8% (7) | 44·4% (4) | 0% (0) | |
| Metformin | 65·7% (23) | 90·9% (10) | 61·5% (8) | 33·3% (3) | 100% (2) | |
| DPP-4 inhibitor | 25·7% (9) | 36·3% (4) | 15·4% (2) | 33·3% (3) | 0% (0) | |
| SGLT2 | 5·7% (2) | 0% (0) | 15·4% (2) | 0% (0) | 0% (0) | |
| Insulin | 34·3% (12) | 18·2% (2) | 61·5% (8) | 11·1% (1) | 50·0% (1) | |
| Biochemical parameters at admission | ||||||
| Serum β-hydroxybutyrate (mmol/L) | 5·0 (3·0 to 6·4) | 6·0 (4·0 to 6·1) | 6·5 (5·0 to 7·2) | 2·1 (1·2 to 3·0) | 6·0 (5·0 to 7·0) | |
| Time to ketone resolution (h) | 24 (15 to 36) | 35 (24 to 60) | 29 (22 to 48) | 10 (6 to 24) | 36 (35 to 36) | |
| Osmolality (mosm/kg) | 304 (292 to 333) | 301 (294 to 303) | 334 (326 to 359) | 299 (292 to 304) | 336 (324 to 347) | |
| Urea (mmol/L) | 10·1 (6·1 to 20·5) | 7·7 (4·2 to 8·6) | 17·1 (7·1 to 23·1) | 6·1 (3·7 to 14·3) | 9·7 (9·2 to 0·1) | |
| Creatinine (mmol/L) | 138 (95 to 232) | 110 (80 to 127) | 170 (113 to 277) | 113 (63 to 201) | 82 (67 to 96) | |
| EGFR | 47 (23 to 71) | 66 (48 to 76) | 42 (21 to 65) | 38 (25 to 67) | 81 (71 to 90) | |
| Glucose (mmol/L) | 28 (18 to 35) | 27 (22 to 31) | 35 (28 to 39) | 18 (14 to 30) | 35 (33 to 37) | |
| HbA1c | ||||||
| mmol/mol | 111 (90 to 132) | 112 (93 to 132) | 112 (88 to 147) | 93 (79 to 118) | 88 (83 to 92) | |
| % | 12·3 (10·4 to 14·2) | 12·4 (10·7 to 14·2) | 12·4 (10·2 to 15·6) | 10·7 (9·4 to 12·9) | 10·2 (9·7 to 10·6) | |
| pH | 7·3 (7·2 to 7·4) | 7·2 (6·9 to 7·3) | 7·3 (7·1 to 7·3) | 7·4 (7·3 to 7·4) | 7·4 (7·4 to 7·5) | |
| Base excess (mmol/L) | −10·1 (−19·0 to −3·2) | −12·6 (−24·9 to −10·4) | −10·2 (−21·1 to −8·8) | −1·4 (−3·0 to 1·97) | −4·05 (−7·8 to −0·3) | |
| Serum bicarbonate (mmol/L) | 15·5 (9·2 to 21·2) | 11·8 (7·8 to 15·4) | 15·5 (7·1 to 17·1) | 22·9 (20·1 to 27·0) | 19·8 (14·9 to 24·8) | |
| Lactate (mmol/L) | 2·5 (1·5 to 3·2) | 2·6 (1·5 to 2·9) | 3·1 (1·9 to 4·9) | 1·7 (1·0 to 2·7) | 2·5 (2·3 to 2·6) | |
| Sodium (mEq/dL) | 138 (133 to 145) | 134 (131 to 136) | 141·5 (138 to 158) | 139 (136 to 144) | 139 (128 to 149) | |
| Potassium (mEq/dL) | 5·1 (4·5 to 5·6) | 5·4 (4·6 to 6·5) | 5·2 (4·5 to 5·9) | 4·8 (4·3 to 5·1) | 4·45 (3·8 to 5·1) | |
| Anion gap (mEq/L) | 12·7 (10·0 to 19·8) | 14·8 (10·4 to 20·5) | 18 (11·9 to 27·5) | 11·1 (7·9 to 15·2) | 12·1 (12·0 to 2·5) | |
| Clinical management | ||||||
| Fluid replacement during 1–4 h (L) | 1·8 (1·0 to 2·3) | 1·3 (1·1 to 2·0) | 1·9 (1·5 to 2·3) | 2·2 (1·7 to 2·5) | 1·5 (1·0 to 2·0) | |
| Fluid replacement on day 1 (L) | 3·5 (3·0 to 4·9) | 3·8 (3·0 to 5·0) | 5·0 (4·0 to 6·0) | 2·0 (1·0 to 2·5) | 5·0 (4·0 to 5·8) | |
| Fluid replacement on day 2 (L) | 4·0 (2·5 to 5·2) | 4·1 (3·0 to 5·3) | 2·0 (1·5 to 3·0) | 2·5 (1·5 to 3·0) | 2·0 (1·5 to 2·8) | |
| Insulin dose day 1 (units/kg per h) | 0·07 (0·04 to 0·09) | 0·09 (0·06 to 0·15) | 0·07 (0·04 to 0·12) | 0·05 (0·03 to 0·07) | 0·06 (0·02 to 0·11) | |
| Hypoglycaemia during treatment | 5·7% (2) | 0% (0) | 15·4% (2) | 0% (0) | 0% (0) | |
| Hypokalaemia during treatment | 22·8% (8) | 36·3% (4) | 15·4% (2) | 22·2% (2) | 100% (2) | |
| Outcome | ||||||
| Length of stay | 12 (4 to 16) | 13 (2 to 21) | 10 (3 to 38) | 13 (3 to 16) | 16 (15 to 17) | |
| Intensive care admission | 22·8% (8) | 27·3% (3) | 23·1% (3) | 11·1% (1) | 50·0% (1) | |
| Mortality | 5·7% (2) | 9·1% (1) | 7·7% (1) | 0% (0) | 0% (0) | |
Data are n (%), median (IQR) for all columns except from HHS (n=2) where values are expressed as median (range). DKA=diabetic ketoacidosis. HHS=hyperosmolar hyperglycaemic state. ARB=angiotensin receptor blocker. ACE=angiotensin-converting enzyme. DPP-4=dipeptidyl peptidase-4. SGLT2=sodium-glucose co-transporter-2. EGFR=epidermal growth factor receptor.