Vomiting and hyperkalemia are novel clues for emergency room diagnosis of type 1 diabetic ketoacidosis: a retrospective comparison between diabetes types

Introduction Diabetic ketoacidosis (DKA) is an acute life-threatening complication in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Causes, underlying pathophysiology, and mortality differ significantly by diabetes type, which initial treatment is dependent on, but few reports on these differences are available. This study aimed to clarify differences in clinical characteristics between the diabetes types to extract important clinical clues for preventing DKA and ensuring appropriate initial treatment in the emergency room. Methods We retrospectively analyzed the clinical presentation of 24 T1DM patients and 13 T2DM patients admitted with DKA to Kobe City Medical Center West Hospital between April 2006 and December 2018. Results In T1DM, the main causes were insulin omission and new onset, and important factors were also misdiagnosis with consequent inappropriate insulin prescription and older age with dementia. In T2DM, the main causes were infection and excessive soft drink consumption. For all soft drink ketosis patients, this was the first presentation of diabetes. The main complaint differed between diabetes types. Vomiting was a characteristic symptom in T1DM DKA; most T2DM DKA patients presented with generalized malaise or decreased level of consciousness. On blood examination, serum potassium level was higher and HbA1c was lower in T1DM DKA. Conclusions To prevent DKA, it is important to provide social support for elderly patients with T1DM DKA and lifestyle intervention for younger T2DM or obese patients. Vomiting and serum potassium levels contribute to the classification of diabetes type and subsequent initial treatment in the emergency room.