• Rachel Teixeira Leal Nunes, Carolina Frade Magalhães Girardin Pimentel Mota, Paulo Ricardo Gessolo Lins, Fernanda Salles Reis, Thais Castanheira de Freitas Resende, Ludmila de Andrade Barberino, Pedro Henrique Luiz da Silva, and Aecio Flavio Teixeira de Gois.
• MD, MSc. Physician, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
• Sao Paulo Med J. 2021 Jan 1; 139 (1): 10-17.

BackgroundDiabetic ketoacidosis is the most frequent hyperglycemic complication in the evolution of diabetes mellitus. Common precipitating factors include newly diagnosed diabetes mellitus, noncompliance with therapy and infections. However, few studies have been conducted in Brazil and none were prospective in design.ObjectiveTo describe the incidence, clinical and laboratory characteristics and precipitating factors of diabetic ketoacidosis among emergency department patients in a tertiary-level teaching hospital in Brazil. We also aimed to identify immediate and long-term mortality within two years.Design And SettingProspective prognosis cohort study conduct at a tertiary-level teaching hospital in São Paulo, Brazil.MethodsAll patients > 12 years old presenting diabetic ketoacidosis who were admitted to the emergency department from June 2015 to May 2016 were invited to participate.ResultsThe incidence of diabetic ketoacidosis per 1,000 admissions was 8.7. Treatment noncompliance and infection were the most common causes of diabetic ketoacidosis. The immediate mortality rate was 5.8%, while the six-month, one-year and two-year mortality rates were 9.6%, 13.5% and 19.2%, respectively. Death occurring within two years was associated with age, type 2 diabetes, hypoalbuminemia, infection at presentation and higher sequential organ failure assessment (SOFA) score at admission.ConclusionsDiabetic ketoacidosis among patients presenting to the emergency department was relatively frequent in our hospital. Treatment noncompliance and infection were major precipitating factors and presence of diabetic ketoacidosis was associated with immediate and long-term risk of death.

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