Clinical profiles in adult diabetic ketoacidotic patients in a tertiary referral medical center in southern Taiwan.

Diabetic ketoacidosis (DKA) is not rare among adults. We retrospectively analyzed the precipitating factors, diabetic history, clinical features, and outcomes of adult DKA patients treated at a tertiary referral medical center in southern Taiwan between January 1994 and May 1996. Seventy-eight patients, aged from 18 to 80 years (median 47), had 87 episodes of DKA (44 males had 49 episodes; 34 females had 38 episodes). Twenty-two episodes occurred in patients with no history of diabetes mellitus (age 18-77 yr, median 40.5). The most common precipitating factor was infection (53 episodes), especially in patients aged more than 40 years. Fifteen patients died during the 87 episodes, giving a case fatality rate of 17%; DKA was precipitated by cerebrovascular accidents in two of the 15 patients and by infection in 13. Among the 53 episodes precipitated by infection, multiple logistic regression analysis showed that old age, requirement for endotracheal intubation, and low body temperature on arrival were associated with fatality. Of the 63 patients who were discharged, 39 required insulin therapy; plasma glucose was well-controlled by oral hypoglycemic agents or diet in only eight (age 29-75 yr, median 57; hemoglobin A1c 5.1-7.8%, median 6.6). The high rate of previously undiagnosed diabetes in adult DKA patients indicates a deficiency in early recognition of, and timely therapy for, diabetes in southern Taiwan.