Clinical and Biochemical Profile of Patients with Diabetes Emergencies: A Cross-sectional Study at a Tertiary Hospital in Northwest Nigeria

Abstract

Abstract Background: Emergency care of patients with diabetes mellitus (DM) employs modern technology often scarce in resource-limited settings. Most studies on DM emergency care in Nigeria lack adequate data on laboratory indices. We aimed to study the clinical and biochemical profile of DM emergency patients managed at a tertiary hospital in Northwest Nigeria. Materials and Methods: This cross-sectional study was conducted at the Aminu Kano Teaching Hospital located in Kano, Northwest Nigeria. Adults with DM emergencies admitted to the emergency department, intensive care and high-dependency units were enrolled and classified as diabetic ketoacidosis (DKA), hyperglycemic-hyperosmolar state (HHS), mixed DKA/HHS, euglycemic-DKA (EDKA) or hypoglycemia based on American Diabetes Association and International Diabetes Federation guidelines. Summary data of clinical and laboratory variables were compared among participant groups. Results: We enrolled 90 participants (58.9% males) with a mean age (± standard deviation) of 50.5 ± 17.6 years. DM emergencies comprised of DKA (33.3%), HHS (31.1%), mixed DKA-HHS (17.8%), hypoglycemia (13.3%) and EDKA (4.4%). DKA was most frequent among previously undiagnosed, newly-diagnosed and young DM patients. Common symptoms of hypoglycemia were palpitations, diaphoresis, headache, and reduced level of consciousness, whereas hyperglycemic emergencies presented with vomiting, chest pain and abdominal pain. Seizures occurred in 31.3% participants with mixed DKA/HHS, but were rare in hypoglycemia, DKA/EDKA and HHS. Glucose levels were highest in those with mixed DKA-HHS and DKA (31.4 ± 2.1 and 30.7 ± 2.9 mmol/L, respectively), while the lowest pH occurred in DKA (6.9 ± 0.18). Hypernatremia was frequent in HHS and DKA-HHS, while hypokalemia was common in DKA-HHS (68.8%), DKA (67.6%) and HHS (42.9%) but rare in hypoglycemia (8.3%). There was no correlation between a DM emergency and glycosylated hemoglobin levels. Conclusions: The common emergencies were DKA, HHS and mixed DKA-HHS. DM emergencies were associated with certain clinical and biochemical anomalies of blood pH, glucose, ketones, and electrolytes.