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Deaths associated with diabetic ketoacidosis and hyperosmolar coma. 1973-1988
P S Hamblin1, D J Topliss, N Chosich
1Ewen Downie Metabolic Unit, Monash University Department of Medicine, Alfred Hospital, Prahran, VIC.
The Medical Journal of Australia
|October 16, 1989
Summary
Diabetic ketoacidosis and hyperosmolar coma management has low mortality from the acute metabolic disturbance itself. However, deaths from associated complications highlight the need for earlier diabetes diagnosis and treatment.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Critical Care Medicine
Background:
- Acute hyperglycaemic complications of diabetes, diabetic ketoacidosis (DKA) and hyperosmolar coma (HOC), are potentially fatal.
- Effective management strategies are crucial for improving patient outcomes.
Purpose of the Study:
- To review mortality data for DKA and HOC to identify areas for management improvement.
- To analyze causes of death and assess potential avoidability.
Main Methods:
- Retrospective review of all deaths in patients with DKA or HOC at Alfred Hospital, Melbourne (1973-1988).
- Inclusion of all late in-hospital deaths.
- Analysis of mortality rates, causes of death, and patient demographics.
Main Results:
- Low mortality (1/610 episodes) directly from the acute metabolic disturbance.
- Overall mortality rate of 6.2% (38 deaths).
- Higher mortality for HOC (14.6%) than DKA (4.9%).
- Deaths often resulted from pneumonia, thrombosis, myocardial infarction, and cerebral hemorrhage.
- Avoidable delays in diagnosis contributed to deaths in HOC patients.
Conclusions:
- Direct mortality from DKA/HOC metabolic disturbance is low.
- Focus should be on earlier diabetes diagnosis.
- Earlier recognition and treatment of pulmonary and vascular complications are essential.
- Further improvements in outcome are challenging but achievable through targeted interventions.