title: Comatose and noncomatose adult diabetic ketoacidosis patients at the University Teaching Hospital, Zambia: Clinical profiles, risk factors, and mortality outcomes.
abstract: BACKGROUND
  Diabetic ketoacidosis (DKA) is one of the commonly encountered diabetes mellitus emergencies.
  
  
  OBJECTIVE
  This study aimed at describing the clinical profiles and hospitalization outcomes of DKA patients at the University Teaching Hospital (UTH) in Lusaka, Zambia and to investigate the role of coma on mortality outcome.
  
  
  METHODS
  This was a cross-sectional analytical study of hospitalized DKA patients at UTH. The data collected included clinical presentation, precipitating factors, laboratory profiles, complications, and hospitalization outcomes. Primary outcome measured was all-cause in-hospital mortality.
  
  
  RESULTS
  The median age was 40 years. Treatment noncompliance was the single highest identified risk factor for development of DKA, followed by new detection of diabetes, then infections. Comatose patients were significantly younger, had lower baseline blood pressure readings, and higher baseline respiratory rates compared to noncomatose patients. In addition, comatose patients had higher baseline admission random blood glucose readings. Their baseline sodium and chloride levels were also higher. The prevalences of hypokalemia, hypernatremia, and hyperchloremia were also higher among comatose patients compared to noncomatose patients. Development of aspiration during admission with DKA, pneumonia at baseline, development of renal failure, and altered mental status were associated with an increased risk of mortality. Development of renal failure was independently predictive of mortality.
  
  
  CONCLUSIONS
  The mortality rate from DKA hospitalizations is high at UTH. Treatment noncompliance is the single highest identifiable precipitant of DKA. Aspiration, development of renal failure, altered sensorium, and pneumonia at baseline are associated with an increased risk of mortality. Development of renal failure during admission is predictive of mortality.
authors.affiliation: Department of Medicine, University Teaching Hospital, University of Zambia School of Medicine, Lusaka, Zambia.
authors.forename: Mwanja
authors.initials: M
authors.lastname: Kakusa
authors.affiliation: Department of Medicine, Endocrine Unit, University Teaching Hospital, University of Zambia School of Medicine, Lusaka, Zambia.
authors.forename: Brown
authors.initials: B
authors.lastname: Kamanga
authors.affiliation: Dermatology and Venereology Division, University Teaching Hospital, University of Zambia School of Medicine, Lusaka, Zambia.
authors.forename: Owen
authors.initials: O
authors.lastname: Ngalamika
authors.affiliation: Department of Medicine, University Teaching Hospital, University of Zambia School of Medicine, Lusaka, Zambia.
authors.forename: Soka
authors.initials: S
authors.lastname: Nyirenda
keywords: Coma; diabetic ketoacidosis; hospitalization outcomes; precipitating factors