From the Guidelines
DKA mortality scoring should prioritize the assessment of severity of acidosis, with severe DKA defined as a pH 7.1 and bicarbonate 5, as it is a potentially life-threatening condition with a higher risk for morbidity and mortality 1. The DKA mortality scoring system is crucial in predicting the risk of death in patients with diabetic ketoacidosis. Key mortality risk factors include the severity of acidosis, with mild DKA defined as a venous pH 7.3 and bicarbonate 15 mmol/l, moderate DKA as a pH 7.2 with a bicarbonate 10, and severe DKA as a pH 7.1 and bicarbonate 5 1.
- The overall mortality for a child with DKA is 1–3% in the United States, although recent reports from tertiary care centers suggest lower mortality rates 1.
- The risk for morbidity and mortality is higher in severe DKA, requiring close physician monitoring, frequently utilizing central venous and intra-arterial pressure monitoring as well as frequent blood chemistry determinations to direct therapy 1.
- Patients with severe DKA should be closely monitored, and management should be guided by the severity of the acidosis, with a focus on aggressive fluid resuscitation, careful electrolyte replacement, and close monitoring of acid-base status.
- The presence of other factors such as coma or altered mental status, high serum osmolality, elevated BUN, and significant comorbidities like cardiovascular disease or infection should also be taken into account when evaluating the mortality risk of a DKA patient.
- Calculating these parameters promptly can help guide management intensity and identify high-risk patients early, allowing for appropriate resource allocation and more intensive interventions to improve outcomes in this potentially life-threatening condition.
From the Research
DKA Mortality Scoring
- There is no direct information available on DKA mortality scoring in the provided studies 2, 3, 4, 5, 6.
- However, the studies discuss the importance of early diagnosis and management of DKA to improve patient outcomes and reduce mortality 2, 3, 5, 6.
- The case fatality rate for DKA is reported to be 1 to 5 percent 6.
- The mortality rate for DKA has declined to low levels in general, but remains high in many developing countries 3.
- Proper management of DKA, including hospitalization, aggressive intravenous fluids, insulin therapy, electrolyte replacement, and identification and treatment of the underlying precipitating event, can help reduce mortality 3, 5, 6.
Risk Factors for DKA Mortality
- Insulin deficiency is the main precipitating factor for DKA 4, 5, 6.
- Infections, new diagnosis of diabetes, and nonadherence to insulin therapy are common precipitating causes for DKA 3, 5.
- The use of sodium-glucose cotransporter-2 inhibitors modestly increases the risk of DKA and euglycemic DKA 5.
- Patient education on how to adjust insulin during times of illness and how to monitor glucose and ketone levels can help prevent DKA and reduce mortality 5, 6.