Retrospective review of clinical and laboratory features of patients presenting with hyperglycemic emergencies

Objective: Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), which are among the acute complications of diabetes, are common and life-threatening hyperglycemic emergencies. Our aim in this research; to define the history, clinical and laboratory characteristics of the patients treated in our clinic due to hyperglycemic emergencies, to determine the predisposing factors and disease course, and to form a resource for the plans to be made to prevent these emergencies and reduce morbidity and mortality. Methods: A total of 153 patients diagnosed with 113 (73.9%) DKA and 40 (26.1%) HHS, who were followed up in the Endocrinology Department of Mersin University Medical Faculty Hospital between 01.01.2019 and 15.02.2022, admitted to this study with a hyperglycemic emergency was included. Demographic data, disease history, physical examination and laboratory findings, symptoms, medicine use history, precipitating factors for a hyperglycemic emergency, and recovery time from treatment were recorded. The measurements of the patients were examined and compared one by one. Results: The mean age of the patients included in our study was 52.6/year, and the number of men and women was equal. While 37.3% of the patients had Type 1 DM, 62.7% had Type 2 DM. 13% of the patients had newly diagnosed diabetes. Type 1 DM patients had DKA in 96.5%, HHS in 3.5%, DKA in 60.4% and HHS in 39.6% of Type 2 DM patients. 30.7% of the patients had a previous history of DKA or HHS. The mean HBA1c (10.88±2.12) at admission was high in all cases. Among the precipitating factors, the most common causes were infection (37.9%) and diet or drug non-compliance (31.4%). Most of the DKA cases were mild or moderate, and the percentage of severe DKA was low (5.3%). The percentage of severe DKA (83%) in patients with diabetes duration of 5 years or less was higher than in those with diabetes for more than 5 years. The most common infections were urinary tract infection, pneumonia and COVID-19 infection, respectively. The most common comorbidities in the patients were hypertension and coronary artery disease. When DKA and HHS patients were compared in terms of infection, DM duration, and precipitating factors, no statistically significant relationship was found. 8 Conclusion: In our study, we found that the most important predisposing factors that cause hyperglycemic emergencies are infection, diet and treatment non-compliance. In addition, the patients had a history of DKA or HHS in the period before the development of DKA/HHS, and a significant part of their blood sugar regulation was impaired. A significant group of DKA/HHS patients using insulin had impaired glucose regulation despite receiving intensive insulin therapy. The rate of development of severe ketoacidosis was high in patients with a relatively recent diagnosis of diabetes. In conclusion, our findings show us that many cases of DKA and HHS can be prevented with patient education, regular medical check-up, prevention of some infections by vaccination, early diagnosis and appropriate treatment of diabetes. In addition, there is a need to strengthen the diabetes screening network for individuals with more public awareness of diabetes and especially for individuals with diabetes risk factors in our country. Keywords: Diabetes Mellitus, Diabetic Ketoacidosis, Hyperosmolar Hyperglycemic State 9 1.GİRİŞ VE AMAÇ