Abstract

Introduction: Ketoacidosis is the most common hyperglycemic emergency in diabetic patients. Sometimes ketoacidosis can be observed during a decompensation process in diabetic conditions. Its prognosis is related to the identification and treatment of underlying decompensation factors. The objectives of this study were to report on the frequency of ketoacidosis to the Department of Internal Medicine, to identify the decompensation factors observed and highlight the challenges associated with its management.

Patients and Method: We prospectively examined a consecutive series of diabetic patients hospitalized at the PLC from January to July 2013 with a diagnosis of diabetic ketoacidosis. Ketoacidosis was defined as the combination of fasting blood glucose ≥250 mg/dl, glycosuria and ketonuria equal to or greater than two crosses in a semi-quantitative estimate. The study parameters were: the age, the sex, the type and the known duration of evolution of the diabetes, the factors leading to decompensation and challenges related to its management.

Results: During the study period, 23 cases of ketoacidosis were observed out of 350 hospitalized patients,a prevalence of 6%. The sex ratio was 1.87. The average age of patients was 35±10 years with extremes of 16 years and 53 years. Type 2 diabetes was the most common with a prevalence of 77%. Half of the cases (50%) were unknown. All patients had a recorded blood glucose level of above 400mg/dl with at least 2-cross of ketonuria. Eighty-seven percent of the patients have no knowledge of the condition. Three deaths were recorded (13%) among uninsured patients.

The following decompensation factors were observed: rupture of treatment in 7 cases (32%), infection in 17 cases (77%), dietary error in 15 cases (68%), and inadequate treatment in 3 cases (14%), difficulties of insulin therapy in 5 cases (22%). These factors were associated in 10 cases (46%).

Conclusion: Ketoacidosis is common among diabetic patients hospitalized in Malabo. The decompensation factors identified among others are lack of knowledge among target patients.

Keywords: Ketoacidosis, diabetes, decompensation, Equatorial Guinea