[Diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic coma--a reappraisal after seven years]

In treating DKA and HHNK, low dose insulin therapy has been confirmed to be efficient and with less complications than traditional high dose insulin therapy. In 1981, we have reported 157 cases of DKA and HHNK at VGH. Between January 1986 and December 1987, 98 cases of DKA and HHNK were encountered at VGH. 40 patients had 48 episodes of DKA their mean age were 56 years. Comparing with the previous report, we found that the main precipitating factors were infection (41.6% vs 38.8%), omission of insulin (27.1% vs 34.7%) and there were cases without any precipitating factors (18.7% vs 24.8%). 3 cases died (6.2% vs 7.3%) in three days. During treatment, hypoglycemia were found in 4 cases (8.3% vs 5.2%) and hypokalemia were noted in 30 cases (62.5% vs 42.3%). 47 patients had 50 episodes of HHNK, their mean age were 68.7 years. Comparing with the previous experience, the main precipitating factors were infection (44% vs 45.7%), omission of insulin (16% vs 20%) and cardiovascular disorder (12% vs 31.4%), there were some episodes without any precipitating factors (20% vs 8.6%). 10 cases died (20% vs 20%) in three days, hypoglycemia were noted in 2 cases (4% vs 3%) and hypokalemia in 20 cases (42% vs 27.3%). It seems, even with better knowledge, facilities and increased experience in the management of diabetic emergencies, no dramatic change in morbidity and mortality was noted over the past 7 years.