Incidences and Outcomes of Hyperglycemic Crises:
A 5-Year Study in a Tertiary Care Center in Thailand
Pimjai Anthanont MD*,
Thana Khawcharoenporn MD, MSc**, Thipaporn Tharavanij MD*
Affiliation :
* Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine,
Thammasat University, Pathumthani, Thailand
** Division of Infectious Diseases, Department of Medicine, Faculty of Medicine,
Thammasat University, Pathumthani, Thailand
Objective : To assess the incidences and outcomes of hyperglycemic crises.
Material and Method: A retrospective study of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)
in adults with type 1 or type 2 diabetes mellitus (DM) admitted to Thammasat Hospital between 2006 and 2010 was
performed. Incidences, precipitating causes, clinical and laboratory characteristics, and treatment outcomes of hyperglycemic
crises were obtained via medical record review. Multivariate logistic regression analysis was used to determine predictors
for mortality.
Results : Eighty-three patients were eligible and included. The mean age was 54.9 17.7 years old. Most subjects had
type 2 DM (86.7%). The 5-year incidence of hyperglycemic crises was 7.46%. Diabetic ketoacidosis occurred more
frequently than HHS (4.67% vs. 1.71%). During the hyperglycemic episodes, the mean plasma glucose level on admission
was 741.3 320.8 mg/dL. Infections were the most common precipitating factor [61/83 (73.5%)], followed by non-compliance
with treatments [35/83 (42.2%)]. Treatment complications included recurrent hyperglycemia (69.9%), hypokalemia (48.2%),
hypernatremia (21.7%), and hypoglycemia (15.7%). The overall mortality rate of hyperglycemic crises was 8.4% (5.8%
in DKA, 15.8% in HHS and 8.3% in the overlap of both conditions). The most common causes of death were infections
[5/7 (71.4%)]. By multivariate analysis, serum sodium level on admission was independently associated with mortality
(adjusted odds ratio 1.08, 95% CI 1.01-1.16, p = 0.03).
Conclusion : Hyperglycemic crises were common in the authors’ setting. Diabetic ketoacidosis occurred more frequently
but had a lower mortality rate than HHS. Complications from hyperglycemic crisis treatment could be prevented by close
monitoring, while high serum sodium level on admission was a predictor for mortality. Strategies to prevent infections and
improve treatment compliance are needed to reduce the incidence of hyperglycemic crises among patients with DM.
Keywords : Hyperglycemic crises, Mortality rate, Complications, Adults, Thai
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