• Muhammad Owais Rashid Aga Khan University Hospital Karachi
  • Aisha Sheikh Aga Khan University Hospital Karachi
  • Abdus Salam Aga Khan University Hospital Karachi
  • Saad Farooq
  • Zareen Kiran Aga Khan University Hospital
  • Najmul Islam Aga Khan University Hospital


Background: Diabetes is undoubtedly one of the most challenging health problems of the 21st century. It is well known that diabetes once develop can lead to several complications. Diabetic ketoacidosis (DKA) is one of the life-threatening complications of diabetes. This study was designed to determine the frequency of DKA in diabetes patients and find out the clinical and biochemical determinants of DKA. Methods: This descriptive study was conducted at Aga Khan University Hospital (AKUH) Karachi, Pakistan from January 2010 to February 2016. All known or newly diagnosed diabetic patients of >16 years of age irrespective of gender and type of diabetes were included. Information regarding patient’s demographics, presenting symptoms, precipitating causes of DKA, biochemical profiles and outcome at the time of discharge was collected. Results: Majority (54.7%) had moderate and 12.4% had severe DKA at presentation. Previous history of DKA was found higher in type 1 diabetes patients (T1DM) (14%) as compare to (4%)  type 2 diabetes patients (T2DM) (p<0.05). DKA severity was observed more (12%) in newly diagnosed (T1DM) (p<0.05). Comorbidities were found more (81%) in (T2DM) (p<0.05) Mortality was also observed higher in Type 2 diabetes patients (p<0.05). Conclusion: Majority of the diabetics had moderate to severe DKA at presentation. Mortality and morbidity related with DKA was found considerably higher among patients with T2DM while infection, myocardial infarction and stroke found as triggering factors in these patients.Keywords: Diabetic ketoacidosis (DKA); T1DM; T2DM

Author Biography

Abdus Salam, Aga Khan University Hospital Karachi



Kamata Y, Takano K, Kishihara E, Watanabe M, Ichikawa R, Shichiri M. Distinct clinical characteristics and therapeutic modalities for diabetic ketoacidosis in type 1 and type 2 diabetes mellitus. J Diabetes Complications 2017;31(2):468–72.

Huri HZ, Foong GT, Pendek R, Widodo RT. Different characteristics of diabetic ketoacidosis between type 1 and type 2 diabetes patients in Malaysia. Asian Biomed 2009;3(2):201–5.

Kitabchi AE, Hirsch IB, Emmett M. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Treatment. [Internet]. Uptodate.com. 2016 [cited 2016 Aug 16]. Available from: http://www.uptodate.com/contents/diabetic-ketoacidosis-and-hyperosmolar-hyperglycemic-state-in-adults-treatment

Newton CA, Raskin P. Diabetic Ketoacidosis in Type 1 and Type 2 Diabetes Mellitus Clinical and Biochemical Differences. Arch Intern Med 2004;164(17):1925–31.

Yamada K, Nonaka K. Diabetic Ketoacidosis in Young Obese Japanese Men. Diabetes Care 1996;19(6):671.

Maldonado M, Hampe CS, Gaur LK, D’Amico S, Iyer D, Hammerle LP, et al. Ketosis-Prone Diabetes: Dissection of a Heterogeneous Syndrome Using an Immunogenetic and β-Cell Functional Classification, Prospective Analysis, and Clinical Outcomes. J Clin Endocrinol Metab 2003;88(11):5090–8.

Balasubramanyum A, Zern JW, Hyman DJ, Pavlik V. New profiles of diabetic ketoacidosis type 1 vs type 2 diabetes and the effect of ethnicity. Arch Int Med 1999;159(19):2317–22.

Xu Y, Bai J, Wang G, Zhong S, Su X, Huang Z, et al. Clinical profile of diabetic ketoacidosis in tertiary hospitals in China: a multicentre, clinic-based study. Diabet Med 2015;33(2):261–8.

Henriksen OM, Roder ME, Prahl JB, Svendsen OL. Diabetic ketoacidosis in Denmark. Incidence and mortality estimated from public health registries. Diabetes Res Clin Pract 2007;76(1):51–6.

Tan H, Zhou Y, Yu Y. Characteristics of diabetic ketoacidosis in Chinese adults and adolescents – a teaching hospital-based analysis. Diabetes Res Clin Pract 2012;97(2):306–12.

Smiley D, Chandra P, Umpierrez GE. Update on diagnosis, pathogenesis and management of ketosis-prone Type 2 diabetes mellitus. Diabetes Manag (Lond) 2011;1(6):589–600.

McGuire S. Centers for Disease Control and Prevention. 2013. Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies. Atlanta, GA: U.S. Department of Health and Human Services, 2013. Adv Nutr 2014;5(3):291–2.

Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care 2009;32(7):1335–43.

Savage MW, Dhatariya KK, Kilvert A, Rayman G, Rees JA, Courtney CH, et al. Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis. Diabet Med 2011;28(5):508–15.

Lin SF, Lin JD, Huang YY. Diabetic ketoacidosis: comparisons of patient characteristics, clinical presentations and outcomes today and 20 years ago. Chang Gung Med J 2005;28(1):24–30.

Jabbar A, Farooqui K, Habib A, Islam N, Haque N, Akhter J. Clinical characteristics and outcomes of diabetic ketoacidosis in Pakistani adults with Type 2 diabetes mellitus. Diabet Med 2004;21(8):920–3.

Qari F. Clinical Characteristics of Patients with Diabetic Ketoacidosis at the Intensive Care Unit of a University Hospital. Pak J Med Sci 2015;31(6):1463–6.

Barski L, Nevzorov R, Rabaev E, Jotkowitz A, Harman-Boehm I, Zektser M, et al. Diabetic ketoacidosis: clinical characteristics, precipitating factors and outcomes of care. Isr Med Assoc J 2012;14(5):299–303.

Kitabchi AE, Umpierrez GE, Murphy MB, Kreisberg RA. Hyperglycemic Crises in Adult Patients with Diabetes: A consensus statement from the American Diabetes Association. Diabetes Care 2006;29(12):2739–48.

Venkatesh B, Pilcher D, Prins J, Bellomo R, Morgan TJ, Bailey M. Incidence and outcome of adults with diabetic ketoacidosis admitted to ICUs in Australia and New Zealand. Critical Care 2015;19:451.

MacIsaac RJ, Lee LY, McNeil KJ, Tsalamandris C, Jerums G. Influence of age on the presentation and outcome of acidotic and hyperosmolar diabetic emergencies. Int Med J 2002;32(8):379–85.



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