The Significance of an Increased Beta-Hydroxybutyrate at Presentation to the Emergency Department in Patients with Diabetes in the Absence of a Hyperglycemic Emergency
Table 1
Characteristics of patients with diabetes presenting to the emergency department, stratified by beta-hydroxybutyrate category or presence of hyperglycemic emergency.
Beta- mmol/L (low-ketone group)
Beta- mmol/L (ketosis without DKA)
DKA
HHS
Number (%)
323 (79.9)
58 (14.4)
17 (4.2)
6 (1.5)
Age year median (IQR)
72.2 (22.5)
63.4 (34.3)
48.9 (44.6)#
77.1 (39.6)
Men (%)
57.6
60.3
61.1
0
Type of diabetes (%)
T1
12.1
19.0
72.2
0
T2
83.9
72.4
16.7
100
T3
2.8
5.2
11.1
0
Use of SGLT2i at presentation (%)
3.4
5.2
0
0
Use of insulin at presentation (%)
52.8
53.4
81.3
33.3
Admitting team
Surgery
10.5
10.3
-
-
Cardiac
12.4
8.6
-
-
Respiratory
7.4
5.2
-
-
Geriatric
12.1
17.2
-
33.3
Other medical
30.0
31.0
100
66.7
Discharge from ED
25.7
25.9
-
-
Length of stay median (IQR)
3.0 (7.2)
4.2 (7.3)
3.2 (4.1)
3.5 (10.5)
In-hospital death percent
5.1
5.3
4.9
8.6
Reduced oral intake at presentation (%)
15.2
32.8
55.6
16.7
Vomiting at presentation
13.6
19
72.2
0
Acute ethanol at presentation (%)
3.4
8.6
16.7
0
SIRS (%)
22.6
41.4
44.4
50.0
qSOFA (%)
1.9
5.2
0
0
Charlson score Arbitrary units (IQR)
3 (2)
2.8 (2.0)
2.1 (1.5)
1.4 (1.5)
Glucose (mmol/L) Median (IQR)
10.4 (9.9)
19 (8.8)#
29.8 (14.4)#
30.4 (12)#
Beta-hydroxybutyrate (mmol/L) Median (IQR)
0.2 (0.3)
2.1 (1.5)
6.3 (0.4)
1.5 (3.0)
Lactate (mmol/L) Median (IQR)
2.3 (1.8)
2.4 (2.2)
2.1 (0.2)
1.9 (1.0)
eGFR (mL/min/1.73 m2) Median (IQR)
57.5 (53)
65 (58)
75 (36)
55 (48)
Bicarbonate (mmol/L) Median (IQR)
24.8 (4.7)
22.6 (6.2)#
12.3 (5.0)#
24.8 (9.4)
Anion gap Median (IQR)
12.6 (4.2)
14.8 (6.1)#
27.1 (6.0)#
17.2 (5.9)
Standard base excess
0.6 (4.3)
-1.8 (6.5)#
-14 (5.6)#
0.3 (8.9)
HbA1c (%) Median (IQR)
8.0 (3.3)
8.8 (5.4)#
9.4 (1.3)#
14.0 (9.1)#
WCC (cells/μL) Mean (IQR)
10.2 (5.9)
12.7 (6.1)#
15.5 (9.0)#
10.5 (4.6)
across groups. # compared with the no-ketosis group.
