a study of the clinical manifestations, biochemical findings, precipitating factors and complications in 56 episodes of diabetic ketoacidosis

fifty six episodes of dka occurred in 33 patients during the period between 1998 -96. these patients were admitted and treated in bahrami children hospital, a tehran university teaching medical center. the most frequent clinical manifestations consisted of polyuria and polydipsia (66%), nausea and vomiting (64%), reduction in consciousness (53%), and kussmaul respiration (53.5%). 54.6% of dka episodes showed a ph below 7.1. there was a relationship between the severity of acidosis and the time needed for its correction. complications during treatment appeared in 47.5% of dka attacks, hypokalemia (18.8%), hyperkalemia (16%) , hypoglycemia (10%) were the most common. no brain edema or death occurred in our patients. the most common precipitating factors of dka include unavailability of insulin or syringes (39.4%), infections (32%), and unknown causes (28.6%). the patients were divided in two different groups. the first group experienced 31 episodes of dka in known patients suffering from diabetes mellitus and receiving insulin treatment. 25 episodes of dka occurred in the second group with no previous history of diabetes; of interest is the finding that in 75% of recurrent attacks in group 1, the unavailability of insulin or syringes was the precipitating factor. the clinical, laboratory and complications of these two groups of patients were studied and the results obtained were compared with similar studies in other countries.