Proportions were used to calculate incidence rates. Data were analysed using JMP 12 software with standard statistical methods. Overt bleeding was considered when the patient had frank hematemesis, coffee-ground emesis, melena or rectal bleeding.Ī manual chart review was conducted by individual internal medicine physicians and endoscopic details were reviewed by gastroenterology faculty members. Occult bleeding is defined as a positive hemo-occult performed on stool samples obtained during a suspected gastrointestinal-bleeding episode. Individuals with gastrointestinal bleeding were further subdivided into those with overt bleeding or those with occult bleeding. All endoscopies were performed under monitored anesthesia care or general anesthesia delivered by a team of anesthesiologists and certified registered nurse anesthetists.īased on the occurrence of gastrointestinal bleeding, study individuals were subdivided into two groups: those with or without gastrointestinal bleeding. All endoscopies were performed by one of the nine gastroenterologists at the hospital-based endoscopic center. We also documented the all-cause mortality rate during that specific hospitalization.ĭetails about endoscopy and endoscopic interventions were obtained from ProVationMD, which is the hospital’s electronic endoscopy database. Hospitalization characteristics such as overall length of stay and critical-care length of stay, vasopressor use and requirement for mechanical ventilation that may contribute to in-patient morbidity were recorded. Laboratory data that included electrolytes, renal function, anion gap and lactate levels were obtained at the admission and 24 hours after resuscitation. Baseline demographic data including age, gender and ethnicity were collected. All individuals aged 18 years and above were included in the study. The diagnosis and management of DKA were according to current critical-care protocols. Patient records were searched in the hospital’s electronic medical-record database for discharge diagnosis carrying ICD 9 (250.10) and ICD 10 (E13.10) codes.ĭKA is defined as elevated blood glucose, presence of ketones in blood or urine and metabolic acidosis accompanied by anion gap. We included all patients admitted with the diagnosis of DKA to our institution. This study was approved by the Institutional Review Board at our institution, Bronx Lebanon Hospital Center, New York. The study also was aimed to look at the endoscopic details and associated therapeutic interventions performed.Ī retrospective chart review was conducted between January 2010 and December 2015. We hypothesized that demographic, clinical and laboratory variables may contribute to the gastrointestinal bleeding in this cohort. In this regard, we have attempted to evaluate the incidence of gastrointestinal bleeding in the setting of DKA. We have identified a need to study the incidence of gastrointestinal bleeding, associated risk factors and the prognosis of such bleeding, as there are not many studies performed from this perspective. Overt gastrointestinal bleeding can be frank hematemesis, coffee-ground emesis, melena or hematochezia. Gastrointestinal bleeding may be overt or occult at presentation. Frequently, gastrointestinal bleeding is associated with DKA and is a common reason to seek in-patient gastroenterology evaluation. DKA is one of the acute complications of uncontrolled diabetes mellitus and may present with a spectrum of gastrointestinal symptoms such as abdominal pain, nausea and vomiting. Diabetic ketoacidosis (DKA) is a common indication for general and critical-care hospitalizations in this population. The estimated prevalence in the United States is 29.1 million, which constitutes about 9.3% of the population. Diabetes mellitus is a worldwide pandemic with ever-increasing prevalence.
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