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Acidosis: the prime determinant of depressed sensorium in diabetic ketoacidosis
Ebenezer A Nyenwe1, Laleh N Razavi, Abbas E Kitabchi
1Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Objective:
The etiology of altered sensorium in diabetic ketoacidosis (DKA) remains unclear. Therefore, we sought to determine the origin of depressed consciousness in DKA.
Research Design And Methods:
We analyzed retrospectively clinical and biochemical data of DKA patients admitted in a community teaching hospital.
Results:
We recorded 216 cases, 21% of which occurred in subjects with type 2 diabetes. Mean serum osmolality and pH were 304 +/- 31.6 mOsm/kg and 7.14 +/- 0.15, respectively. Acidosis emerged as the prime determinant of altered sensorium, but hyperosmolarity played a synergistic role in patients with severe acidosis to precipitate depressed sensorium (odds ratio 2.87). Combination of severe acidosis and hyperosmolarity predicted altered consciousness with 61% sensitivity and 87% specificity. Mortality occurred in 0.9% of the cases.
Conclusions:
Acidosis was independently associated with altered sensorium, but hyperosmolarity and serum "ketone" levels were not. Combination of hyperosmolarity and acidosis predicted altered sensorium with good sensitivity and specificity.
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