Diabetic Ketoacidosis (DKA) Hospitalizations and Reduce Length of Stay of an Adult Patient with Diabetic Ketoacidosis Attending the Emergency Room of King Abdul-Aziz University Hospital-Diabetic Center in Jeddah From 2015-2019

Abstract

Background

      Diabetic Ketoacidosis (DKA) is a serious and potentially a fatal complication of diabetes mellitus. Diabetic Ketoacidosis (DKA) is a metabolic emergency characterized by the triad of hyperglycemia, high-anion gap metabolic acidosis and ketonemia. Despite its multifactorial etiology, DKA is known to be a preventable acute complication of diabetes mellitus specifically through patient education. Diabetic ketoacidosis(DKA) is the most common hyperglycemic emergency and causes the greatest risk for death in patients with diabetes mellitus, almost a third of the cases occur among those with type 2 diabetes. Although mortality rates from DKA have declined to low levels in general, it continues to be high in many developing countries. DKA is characterized by hyperglycemia, metabolic acidosis and ketosis. Proper management of DKA requires hospitalization for aggressive intravenous fluids, insulin therapy, electrolyte replacement as well as identification and treatment of the underlying precipitating event along with frequent monitoring of patient’s clinical and laboratory states. Aim of the study: To determine the length of stay and ICU transferee in Diabetic center in Jeddah at Saudi Arabia. To describe the clinical and biochemical characteristics of Diabetic ketoacidosis severity of ICU admission. Method: Retrospective observational cohort study of patients with DKA to define the clinical and biochemical characteristics of Diabetes Ketoacidosis at King Abdul-Aziz University Hospital-Diabetic Center in Jeddah. The study included physicians working in the diabetic center that care for DKA patients and follow up diabetic patients. They identified all patients from 2015-2019 with DKA from the medical records. Result: There was statistically significant difference in mean of LOS across all years (<0.05). The length of stay in our institute was statistically and graphically shorter than national benchmark to reach 15 hour shorter in 2019.  BY doing a multivariate regression analysis, it has been found that presence of ketoacidosis, anion gap, change in bicarbonate level and resorption of DKA in hours are statistically significant and regarded as determinants of LOS in DM patients. Conclusion: Decrease length of hospital stay is highly dependent on severity of condition, metabolic derangement the clinical pathways are known to decrease practice variations and improve several essential patient-, practicing physician-and hospital-related outcomes including satisfaction with the service, reduction of work-load, and cutting hospital care costs.