Infection as a trigger of diabetic ketoacidosis in intensive care-unit patients.
We determined the prevalence and indicators of infection in intensive care unit (ICU) patients with diabetic ketoacidosis (DKA) by performing a retrospective analysis of 123 episodes of DKA (in 113 patients) managed in a medical ICU between 1990 and 1997. In univariate analysis, features associated with infection were female sex, neurological symptoms at admission, fever during the week before admission, a need for colloids, a high blood lactate level at admission, and lack of complete clearance of ketonuria within 12 h. Multivariate analysis identified 3 independent predictors of infection: female sex (odds ratio [OR], 2.31; confidence interval [CI], 1.05-5.35), neurological symptoms at admission (OR, 2.83; CI, 1.18-6.8), and lack of complete clearance of ketonuria within 12 h (OR, 3.73; CI, 1.58-9.09). Infection is the leading trigger of DKA in ICU patients. Neurological symptoms at admission and lack of complete clearance of ketonuria within 12 h are useful warning signals of infection.
Azoulay
E
E
Intensive Care Unit, Saint-Louis Teaching Hospital and Paris 7 University, Paris, France. elie.azoulay@sls.ap-hop-paris.fr
Chevret
S
S
Didier
J
J
Barboteu
M
M
Bornstain
C
C
Darmon
M
M
Le Gall
J R
JR
Vexiau
P
P
Schlemmer
B
B
D000328:Adult; D002254:Carbonates / Q000627:therapeutic use; D003102:Colloids / Q000627:therapeutic use; D016883:Diabetic Ketoacidosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000503:physiopathology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007239:Infections / Q000150:complications*; D007328:Insulin / Q000627:therapeutic use; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010710:Phosphates / Q000627:therapeutic use; D012189:Retrospective Studies
D002254:Carbonates; D003102:Colloids; D007328:Insulin; D010710:Phosphates