Pattern of Electrolyte Imbalance in Hospitalized Diabetic Patients: Experience in a Tertiary Care Hospital

Introduction: Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) is the largest specialized hospital in Bangladesh for care of diabetic patients. Here, most of the hospitalized patients are diabetic, having many complications of diabetes mellitus and other co-morbidities. They often require multiple drugs for treatment. Diabetes mellitus itself, its complications and various medicationsall are related to development of electrolyte imbalance, which are often under-estimated or remain un-diagnosed. Objectives: The Objectives of this study were to see the pattern of electrolyte imbalance in hospitalized diabetic patients and to find out the precipitating causes behind them. Methods: This cross-sectional study was done in the Department of Internal Medicine, BIRDEM in 2008. Data were collected by random sampling from the first 100 adult diabetic patients with electrolyte imbalance, irrespective of their cause of admission. Results: Total number of patients were 100, male were 74 and female were 26 (M:F ratio 2.85: 1). Mean age was 60.18 years with standard deviation of ± 12.15 years (Range 38- 90 years). Among the patients, the mean duration of the diabetes mellitus was 10.96 years with standard deviation ± 8.05 years. Majority (83%) of the patients were on insulin, 22% were on oral anti-diabetic agents and 6% were on medical nutrition therapy. Among the co-morbidities, hypertention was the most prevalent (61%), followed by ischaemic heart disease (24%), chronic kidney disease (21%), dyslipidaemia (8%) and fatty liver (4%). Diabetic peripheral neuropathy was present in 41% cases, nephropathy in 13% cases and retinopathy in 12% cases. Over all 78% (100 patients had electrolyte imbalance out of 128 patients) of patients had some sort of electrolyte imbalance, irrespective of cause of admission. Hyponatraemia was the most common electrolyte imbalance in this study (80%), followed by hypomagnaesemia (38%), hypokalaemia (36%) and hyperkalaemia (14%). In 11% cases there were hyponatraemia, hypokalaemia and hypomagnaesemia. Regarding the precipitating factors, vomiting was most common (51%). In 28% cases electrolyte imbalance was precipitated by various drugs. Diarrhea and renal failure were responsible in a minority of cases. In 4% cases no cause could be identified. No death occurred. Conclusion: From this cross-sectional study it can be concluded that, electrolyte imbalance is common in hospitalized diabetic patients. Serum electrolytes should be checked routinely in hospitalized diabetic patients irrespective of their purpose of admission. DOI: http://dx.doi.org/10.3329/birdem.v2i1.12355 Birdem Med J 2012; 2(1) 14-18