[25 years experiences on diabetic ketoacidotic patients]

In the past 25 years the authors regularly assessed the clinical characteristics of patients with diabetic ketoacidosis who were admitted to their diabetes unit.

The aim was to examine the possible changes in the incidence, causes, treatment and mortality of diabetic metabolic disorders.

Retrospective analysis of the data obtained by the assessment of case histories.

Between 1981 and 2005, 288 patients were admitted with 364 ketoacidotic episodes. The mean age of the patients was 42 +/-16.9 -- 53.2 +/- 12.6 years. Approximately 60% of them had type 1 diabetes and the proportion of the male patients was almost the same. The mean duration of diabetes was 7.8 +/- 8.1 -- 10 +/- 7.1 years. The ratio of manifest comas was approximately 10%. Among the precipitating factors the dominance of infections decreased (from 77.3% to 50.4%). During the treatment the aim of the authors was to supply fluids and electrolytes properly and to administer insulin for a prolonged period of time and in a dose as small as possible. The dose of the insulin bolus significantly decreased in the last period (8.29 +/- 4.31 U; p < 0.05). In the observed period 43 patients died (14.93% of the patients), the mortality rate decreased to 7.2% during the last period.

Despite the intensive education, care and treatment of diabetic patients, the number of hospitalizations due to diabetic ketoacidosis has not decreased. In order to prevent ketoacidotic episodes proper team work is needed in the management of diabetic patients.