Aálisis de criterios ada en pacientes diabéticos como factor de riesgo para el desarrollo de cetoacidosis diabética. en pacientes atendidos en el Hospital Teodoro Maldonado Carbo. período 2019 - 2021
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2022
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Carrera de Medicina
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Introducción: La cetoacidosis diabética es una de las complicaciones hiperglucémicas agudas de la diabetes mellitus (DM), su tasa de mortalidad varía entre el 2% al 40%, dependiendo de la región. Los pacientes con DM1 son los más susceptibles a desarrollar CAD, pero aquellos con DM2 también tienen riesgo a desarrollarla debido a infecciones, mala adherencia al tratamiento, entre otros. En la actualidad para su diagnóstico se emplean los criterios ADA del 2009 que se basan en diferentes valores de laboratorio, así como en manifestaciones clínicas y estos incluyen glucosa plasmática, pH arterial, bicarbonato sérico, acetoacetato en orina, brecha aniónica y estado de conciencia.
Objetivo: Analizar los criterios ADA en pacientes diabéticos como factor de riesgo para el desarrollo de cetoacidosis diabética en el Hospital Teodoro Maldonado Carbo, enero 2019 - septiembre del 2021.
Metodología: La siguiente investigación es de tipo cuantitativo, descriptivo, analítico, retrospectivo y de corte transversal.
Resultados: La CAD tuvo mayor frecuencia en el sexo femenino con 50.8% de los casos totales, mientras que el grupo etario más afectado fue de 41 a 64 años con el 68%, el factor precipitante asociado con mayor frecuencia al desarrollo de CAD es de origen infeccioso, en donde la neumonía prevaleció con un 36.6%. Al analizar las variables de los criterios ADA y realizar un comparativo con los criterios de Reino Unido, los criterios ADA siguen siendo los más factibles para diagnóstico y clasificación de la severidad a excepción de la glucosa plasmática.
Recomendaciones: Realizar una historia clínica completa, no olvidar preguntar el medicamento con el que recibe tratamiento y al menos solicitar un uroanálisis antes de descartar CAD, investigar más a fondo casos de CAD euglicemicas sobre todo a aquellos pacientes que emplean en su tratamiento a los inhibidores del cotransportador sodio-glucosa tipo 2 (SGLT2).
Introduction: Diabetic ketoacidosis is one of the acute hyperglycemic complications of diabetes mellitus (DM), its mortality rate varies between 2% to 40%, depending on the region. Patients with DM1 are the most susceptible to develop DKA, but those with DM2 are also at risk due to infections, poor adherence to treatment, among others. Currently, the 2009 ADA criteria are used for diagnosis based on different laboratory values as well as clinical manifestations, including plasma glucose, arterial pH, serum bicarbonate, urine acetoacetate, anion gap and state of consciousness. Objective: To analyses the ADA criteria in diabetic patients as a risk factor for the development of diabetic ketoacidosis in the Teodoro Maldonado Carbo Hospital, January 2019 - September 2021. Methodology: The following research is quantitative, descriptive, analytical, retrospective, and cross-sectional. Results: CAD was more frequent in the female sex with 50.8% of the total cases, while the most affected age group was 41 to 64 years with 68%. The precipitating factor most frequently associated with the development of CAD was infectious origin, where pneumonia prevailed with 36.6%. When analysing the variables of the ADA criteria and making a comparison with the UK criteria, the ADA criteria remain the most feasible for diagnosis and severity classification except for plasma glucose. Recommendations: Take a complete medical history, do not forget to ask about the drug you are treated with and at least request a urinalysis before ruling out DKA, further investigate cases of euglycemic DKA especially those patients using sodium-glucose cotransporter type 2 (SGLT2) inhibitors in their treatment.
Introduction: Diabetic ketoacidosis is one of the acute hyperglycemic complications of diabetes mellitus (DM), its mortality rate varies between 2% to 40%, depending on the region. Patients with DM1 are the most susceptible to develop DKA, but those with DM2 are also at risk due to infections, poor adherence to treatment, among others. Currently, the 2009 ADA criteria are used for diagnosis based on different laboratory values as well as clinical manifestations, including plasma glucose, arterial pH, serum bicarbonate, urine acetoacetate, anion gap and state of consciousness. Objective: To analyses the ADA criteria in diabetic patients as a risk factor for the development of diabetic ketoacidosis in the Teodoro Maldonado Carbo Hospital, January 2019 - September 2021. Methodology: The following research is quantitative, descriptive, analytical, retrospective, and cross-sectional. Results: CAD was more frequent in the female sex with 50.8% of the total cases, while the most affected age group was 41 to 64 years with 68%. The precipitating factor most frequently associated with the development of CAD was infectious origin, where pneumonia prevailed with 36.6%. When analysing the variables of the ADA criteria and making a comparison with the UK criteria, the ADA criteria remain the most feasible for diagnosis and severity classification except for plasma glucose. Recommendations: Take a complete medical history, do not forget to ask about the drug you are treated with and at least request a urinalysis before ruling out DKA, further investigate cases of euglycemic DKA especially those patients using sodium-glucose cotransporter type 2 (SGLT2) inhibitors in their treatment.
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DIABETES MELLITUS, MORTALIDAD, FACTORES DE RIESGO, PRESION ARTERIAL, HOSPITAL DE ESPECIALIDADES DR. TEODORO MALDONADO CARBO, CANTON GUAYAQUIL, ECUADOR