THỰC TRẠNG ĐIỀU TRỊ NHIỄM TOAN CETON MỨC ĐỘ TRUNG BÌNH VÀ NẶNG DO ĐÁI THÁO ĐƯỜNG TẠI KHOA NỘI TIẾT – THẬN BỆNH VIỆN NHÂN DÂN GIA ĐỊNH TRONG GIAI ĐOẠN 2021 – 2022

Abstract

Background: Diabetic ketoacidosis (DKA) is an acute and life-threatening complication for patients if not detected and treated promptly. The principles of DKA treatment include fluid and electrolyte replacement, continuous intravenous insulin infusion, potassium supplementation, bicarbonate supplementation (when indicated), and treatment of precipitating factors. Research Objectives: To describe and analyze the clinical and laboratory characteristics, treatment features and outcomes of patients with moderate to severe diabetic ketoacidosis treated at the Department of Endocrinology and Nephrology in Nhan dan Gia Dinh Hospital in the period 2021-2022. Research Methods: The study was conducted as a retrospective descriptive case series involving 72 patients who met the sampling criteria. Cases with confounding factors were excluded, including lactic acidosis due to sepsis, drugs, or toxins; hyperosmolar hyperglycemic state; and patients who had received DKA treatment prior to hospital admission. Results: Among the 72 patients analyzed, type 1 diabetes accounted for 22.22% and type 2 diabetes for 77.78%. The leading precipitating factor for DKA was "non-adherence to prescribed therapeutic regimen" (38.89%). The most commonly reported symptoms included nausea/vomiting (61.11%) and excessive thirst (51.39%), while frequent physical findings were dehydration (83.33%) and Kussmaul breathing (63.89%). At admission, the mean serum sodium was 126.96 ± 5.0 mmol/L, potassium 4.82 ± 0.91 mmol/L, blood pH 7.18 ± 0.12, ketones 8.56 ± 2.70 mmol/L, anion gap 25.77 ± 5.32, and HbA1c 12.63 ± 2.98%. Median blood glucose was 31.04 mmol/L (IQR: 21.96–41.06), and bicarbonate (HCO₃⁻) was 6.5 mmol/L (IQR: 3.45–10.28). Regarding treatment, the mean total volume of intravenous fluids administered was 9,485.42 ± 4,283.05 mL, in which 0.9% sodium chloride accounted for a mean of 7,507.64 ± 4,012.22 mL. The median total insulin dose administered via continuous intravenous infusion was 72.75 units (IQR: 47.13–90.63). The median time to DKA resolution was 23.0 hours (IQR: 13.63–40.38); the median time to discontinue continuous insulin infusion was 35.0 hours (IQR: 24.0–45.13); and the median length of hospital stay was 122.5 hours (IQR: 97.25–170.88). Conclusions: Diabetic ketoacidosis is an acute complication characterized by diverse clinical manifestations, most commonly occurring in patients with newly diagnosed diabetes or poor glycemic control. This study provides a comprehensive overview of DKA patients—from presenting symptoms upon admission to treatment outcomes—showing that both DKA recovery time and hospital stay duration were within reasonable ranges.