{"paper_id":"05f4aa96-1934-467b-8f0d-ff4223ec49e9","body_text":"Gender Related Differences in Clinical Presentation and Outcomes of Diabetic Ketoacidosis: A Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Gender Related Differences in Clinical Presentation and Outcomes of Diabetic Ketoacidosis: A Retrospective Study Abdus Salam, Yasir Ali, Owais Rashid, Paghunda Ehsan, Wireko Andrew Awuah, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3824590/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Diabetic Ketoacidosis (DKA) is a well-known complication of Diabetes Mellitus (DM). Many studies have been conducted to observe the characteristics of DKA in both type 1 and type 2 DM. However, little is known about differences in the clinical features and outcomes of patients with DKA in relation to gender. In this study, we aimed to investigate whether there were any gender-related differences in the clinical presentation and outcomes of DKA patients. Methodology : We conducted this retrospective, descriptive study at the Aga Khan University Hospital (AKUH) Karachi, Pakistan, from July 2016 to July 2020. Data of patients above 16 years of age presented to the emergency department with DKA was reviewed. Information was collected regarding patient demographics, presenting symptoms, precipitating causes of DKA, vital signs, biochemical profiles, and outcomes at discharge. Results : Of 234 patients, 120 (51.3%) were males (mean age=46.8±16.6), and 114 (48.7%) were females (mean age=44±18.8). Our results showed that females had a higher chance of having previous episodes of DKA (13.4% vs. 4.2%) than males (p=0.047). There was a higher proportion of New Onset type 1 (24.2%) and New Onset type 2 (5.8%) Diabetes at presentation in male patients, as compared to female patients (14.0 and 1.8%, respectively). More male patients presented with severely altered mental status (24.2%) than female patients (13.2%). The higher biochemical markers in males included Hemoglobin, BUN, Creatinine, and serum osmolality, while Amylase was significantly higher in females. Finally, there were no significant differences in the outcomes between the two groups. Conclusion : As male patients in our population are more likely to present with New Onset type DM and are more likely to present with severe complications, preventive measures targeting male patients with risk factors for DM are paramount. Moreover, educational programs for both genders regarding complications and prevention are required. In order to form such plans, further studies at more centers need to be carried out so recommendations at a national level can be implemented. Diabetic Ketoacidosis Diabetes Gender difference Figures Figure 1 Background Diabetic Ketoacidosis (DKA) is an acute emergency caused by an abnormal imbalance of insulin deficiency and catecholamines/glucagon, resulting in problems like hyperglycemia, metabolic acidosis, and ketosis [ 1 – 3 ]. It is a well-known complication of Diabetes Mellitus (DM) resulting in significant morbidity, mortality, and a remarkable burden on healthcare resources. 9 to 28% of all diabetes-related admissions have been ascribed to DKA [ 1 , 3 ]. There are more than 10000 annual hospital admissions for DKA in the United States of America and between 5000 to 10000 in Canada [ 4 , 5 ]. Previously it was believed that DKA occurs mainly in patients with type 1 DM. However, patients with type 2 DM are prone to develop DKA under stressful conditions such as infections, surgery, or trauma [ 6 ]. According to the literature, the prevalence of type 2 DM is higher than type 1 DM, and the proportion is expected to increase with time; therefore, the presentation of DKA is likely to be higher in patients with type 2 DM, and this might explain the increased hospitalization for DKA [ 7 , 8 ]. Many studies have been conducted to observe the characteristics of DKA in both type 1 and type 2 DM [ 9 – 10 ]. However, little is known about differences in the clinical features and outcomes of patients with DKA concerning gender. Since local data regarding DKA in Pakistan has been very scarce [ 11 ], no studies have been done to elucidate the differences in the clinical features and outcomes of patients with DKA in relation to gender. Consequently, there needs to be more knowledge regarding this disorder's proper diagnosis, prevention, and management [ 12 ]. In this study, we aimed to investigate whether there were gender-related differences in the clinical presentation and outcomes of DKA patients who were admitted through the Emergency Room (ER) at the Aga Khan University Hospital (AKUH). The diverse socio-economic backgrounds of patients presenting to the AKUH provided a study sample representative of the Pakistani population. Materials & Methods We conducted this retrospective, descriptive study at the Aga Khan University Hospital (AKUH), a tertiary care hospital in Karachi, Pakistan. The duration of this study was five years, i.e., from July 2016 to July 2020. The Ethics Review Committee of the institution approved the study. No personal details by any means related to any patient were revealed regarding ethical considerations. Data of all patients aged more than 16 years and presenting with DKA to the emergency department of AKUH was reviewed, and their clinical and biochemical parameters were noted. Patients aged below 16 years and non-diabetics presenting with ketoacidosis were excluded from the study. Computer coding was used to identify admissions with an ICD code for DM and DKA for five years. Diagnostic criteria of the American Diabetes Association (ADA) were used. The diagnosis of DKA was made by the presence of an arterial pH lower than 7.30, an anion gap of less than 15 mmol/L, hyperglycemia, i.e., blood glucose > 250mg/dL, and urine ketone levels of 'moderate' or 'large,' i.e., equal to or more than 2 + or ketonemia measured in the lab. DKA was classified as mild, moderate, or severe according to ADA criteria. Serum osmolality was calculated using the formula, i.e., 2{measured Na + (mEq/l)} + glucose(mg/dl)/18 + (Blood Urea Nitrogen (BUN) / 2.8) and was measured in mosm/kg. Anion gap was calculated using the formula, i.e., {(Na +) − (Cl - + HCO3 -)} (mEq/L). Data was collected for males and females through a questionnaire filled out for the sample population by the data analyst, a team member. Information regarding patient demographics, presenting symptoms, precipitating causes of DKA, vital signs, biochemical profiles at presentation to the emergency department, time from presentation to resolution of urine ketones, insulin dose at discharge, length of hospitalization, and outcome at discharge were collected. Precipitating factors of DKA were defined as conditions leading to the development of DKA, such as inadequate insulin doses or missed insulin doses, sepsis, infection, and surgical stress. For patients presenting with more than one factor, the leading cause was noted. Observation bias was controlled by reconfirmation of collected information from the hospital's records by a second verifier. Confounding factors were rectified through restriction. Patients were classified as Type 2 DM if they had a prior history of treatment (> one year) with diet alone or oral hypoglycemic agents (OHA) or as 'new onset' if the episode of DKA was the first manifestation of diabetes. Patients with new-onset DM were then further classified as type 1 or Type 2 after autoimmune profile results or if they discontinued insulin use without recurrence of DKA for at least one year, respectively. Patient follow-up data were obtained by chart review or telephone contact when necessary. Precipitating factors of DKA were defined as conditions leading to the development of DKA, based on physicians' diagnosis and information obtained from the patient's medical record, like inadequate insulin dose or missed insulin doses, sepsis, any other infection, surgical stress, etc. For patients presenting with more than one factor, the leading cause was accounted. The demographic parameters included gender, age, height, and BMI. Data was analyzed using the SPSS 20 software. Frequency and percentages were computed for categorical variables, i.e., type and duration of DM, previous episode of DKA, presenting symptoms, and severity of DKA. Mean and Standard Deviation were computed for continuous variables, i.e., age, BMI, and biochemical parameters. We used the independent Sample-T test to compare the means of discrete variables of male and female patients. Clustered Bar Chart was obtained for significant categorical variables. We applied the chi-square test to identify significant differences. Results Two hundred thirty-four patients were identified to be admitted with the diagnosis of DKA at AKUH in the mentioned five years. 120 (51.3%) were males (mean age = 46.8 ± 16.6), and 114 (48.7%) were females (mean age = 44 ± 18.8). The comparison of the type of diabetes and patients’ characteristics between the two groups showed significant differences in the previous episodes of DKA. Female patients had a higher chance of having a history of previous episodes of DKA compared to males (13.4% vs. 4.2%, respectively [p-value: 0.047]). There was a significant difference in the type of diabetes between the two DKA groups (p = 0.036). Male patients had a significantly higher proportion of New Onset type 1 (24.2%) and New Onset type 2 (5.8%) at presentation, as compared to female patients in whom the percentage of New Onset type1 and type 2 was only 14.0% and 1.8% (Table 1 ), (Fig. 1). Table 1 Demographics and Past History at the time of presentation to the hospital in Patients with Diabetic Ketoacidosis. Variables Gender P - Value Male Female Number of patients (%) 120(51.3%) 114(48.7%) Age (years) 46.8 ± 16.6 44 ± 18.8 0.21 BMI (kg/m 2 ) 23.1 ± 5.2 23.9 ± 7.2 0.50 Comorbidity present 58(48.3%) 54(47.4%) 0.883 Previous episodes of DKA 5(4.2%) 13(11.4%) 0.047 Oral Hypoglycemic Agents Therapy 37(30.8%) 29(25.4%) 0.275 Insulin Therapy 49(40.8%) 48(42.1%) 0.168 Duration of Diabetes Less than 1 year 5(6.7%) 7(9.2%) 0.190 1 to 5 years 12(16.0%) 22(28.9%) 6 to 10 years 19(25.3%) 18(23.7%) more than 10 years 39(52.0%) 29(38.2%) Cormibidities Hypertension 15(12.5%) 20(17.5%) 0.512 Ischemic Heart Disease 11(9.2%) 4(3.5%) Chronic Kidney Disease 9(7.5%) 6(5.3%) Hypothyroidism 5(4.2%) 8(7.0%) Chronic Liver Disease 6(5.0%) 4(3.5%) Malignancy 6(5.0%) 4(3.5%) Others 6(5.0%) 8(7.0%) Type of Diabetes mellitus Present New Onset Type I 29(24.2%) 16(14.0%) 0.036 Known Type I 23(19.2%) 34(29.8%) Known Type II 61(50.8%) 62(54.4%) Ne Onset Type II 7(5.8%) 2(1.8%) [Data presented as Mean ± Standard Deviation and n (percent)] There was no significant difference in most presenting symptoms among the Male and Female groups. Nevertheless, more male patients presented with severely altered mental status (24.2%) than female DKA patients (13.2%) (p-value: 0.005). (Table 2 ). Table 2 Signs and Symptoms, Altered mental status and severity of Diabetic Ketoacidosis (DKA) in patients with DKA Variables Gender P-Value Male(120) Female(114) Signs and Symptoms Polyuria 19(15.8%) 22(19.3%) 0.486 Polydipsia 17(14.2%) 19(16.7%) 0.596 Polyphagia 8(6.7%) 7(6.1%) 0.869 Weight Loss 11(9.2%) 9(7.9%) 0.728 Nausea 13(10.8%) 19(16.7%) 0.194 Vomiting 48(40%) 59(51.8%) 0.071 Abdominal pain 31(25.8%) 41(36%) 0.093 Diarrhea 17(14.2%) 14(12.3%) 0.671 Fits 5(4.2%) 1(0.9%) 0.112 Altered mental status Mild = Alert 39(32.5%) 26(22.8%) 0.005 Moderate = Alert /drowsy 52(43.3%) 73(64.0%) Severe = Stupor/coma 29(24.2%) 15(13.2%) Severity of DKA Mild DKA 40(33.3%) 37(32.5%) 0.296 Moderate DKA 69(57.5%) 59(51.8%) Severe DKA 11(9.2%) 18(15.8%) The most common precipitating factors in both genders were Infections and medication noncompliance, but there was no significant statistical difference between the two groups (Table 3 ). Table 3 Most common precipitating factors in patients with Diabetic Ketoacidosis (DKA) Precipitating Factors Gender P – Value Male (120) Female(114) Infections 41(34.1%) 44(38.6%) 0.532 Noncompliance 23(19.2%) 17(14.9%) Myocardial Infarction 8(6.7%) 3(2.6%) Stroke 3(2.5%) 2(1.8%) Post-surgery 3(2.5%) 3(2.6%) Steroid Induced 2(1.7%) 3(2.6%) Others 36(30.0%) 31(27.2%) Significant differences were seen in the biochemical findings of male and female DKA patients (Table 4 ). The higher biochemical markers in males included Hemoglobin (13.1 vs. 12.2 [p-value: 0.008]), BUN 35.7 vs. 27.6 [p-value: 0.016]), Creatinine (2.3 vs. 1.6 [p-value: 0.006]), and serum osmolality (309 vs. 298.6 [p-value: 0.004], while Amylase was significantly higher in females (278 vs. 139 [p-value: 0.05]). Table 4 Biochemical profile at the time of presentation to the hospital in patients with Diabetic Ketoacidosis (DKA) Variables Gender P-Value Male Female Hemoglobin(gm/dl) 13.1 ± 2.7 12.2 ± 2.1 0.008 WBC Count (x10E9/L) 15.9 ± 7.3 16.1 ± 7.3 0.821 Platelet Count (x10E9/L) 296 ± 152.3 306.5 ± 130.2 0.594 BUN(mg/dl) 35.7 ± 25.1 27.6 ± 25.8 0.016 Creatinine(mg/dl) 2.3 ± 2.2 1.6 ± 1.2 0.006 Sodium(mmol/L) 132.6 ± 8.4 131 ± 8.5 0.183 Potassium(mm/L) 4.7 ± 1 4.6 ± 1.1 0.503 Chloride (mmol/L) 97.5 ± 9.7 97.2 ± 10 0.799 Bicarbonate 10.6 ± 4.6 10.4 ± 5.2 0.877 Arterial pH 7.2 ± 0.1 7.1 ± 0.1 0.123 pCO2(mmHg) 24 ± 9.6 23.1 ± 8.8 0.388 pO2(mmHg) 119.7 ± 81.3 123.3 ± 72.6 0.730 Amylase 139.1 ± 181 278.3 ± 416.4 0.05 Lipase 107.3 ± 122 231.6 ± 491 0.106 Urinary ketones 2.6 ± 0.5 2.5 ± 0.6 0.434 Random Blood Sugar 499.4 ± 172.1 488 ± 206.2 0.648 Serum Osmolality (mOsm/Kg) 309 ± 29.6 298.6 ± 25.2 0.004 Anion Gap 24.5 ± 7 23.9 ± 7.1 0.491 HbA1C 11.6 ± 3 11.3 ± 2.7 0.609 Urinary Ketones 1 positive 3(2.5%) 9(7.9%) 0.131 2 positive 47(39.2%) 37(32.5%) 3 positive 70(58.3%) 68(59.6%) Interestingly, there were no significant differences in the outcomes of the DKA between the two groups, including mortality, total length of stay, Intensive Care Unit (ICU) stay, or requirement of ventilatory support (Table 5 ). Table 5 Outcomes in Patients with Diabetic Ketoacidosis (DKA) Outcomes Gender P - Value Male Female Mortality Yes 13(10.8) 9(7.9%) 0.441 Length of hospital Stay Less than 5 days 69(57.5%) 75(65.8%) 0.601 5 to 10 days 31(25.8%) 24(21.1%) 10–15 days 12(10.0%) 10(8.8%) More than 15 days 8(6.7%) 5(4.4%) Intensive Care Unit (ICU) Stay Yes 34(28.3%) 31(27.2%) 0.846 Ventilator Support Yes 32(26.7%) 26(22.8%) 0.494 Discussion Previous studies have shown that even though the ratio of men to women afflicted with Diabetes Mellitus is roughly equal, the risk of DKA in women is different from men [ 13 , 14 ]. Some studies reported that women have a 50% higher risk of developing DKA than men. Leonid Barski et al. recorded that most patients with DKA were females (59.5%), confirming the previous literature [ 9 – 10 ]. However, in our study population, a high percentage of patients with DKA was found to be males (51.3%), as opposed to the previous studies that found a high tendency of DKA in female patients [ 9 – 11 ]. Moreover, the high female-to-male ratio is falling with a reduction in the number of episodes occurring in female patients and an increase in the number of episodes occurring in male patients, particularly among those patients with recurrent episodes of DKA [ 12 , 13 ]. In our study, males with DKA were more likely to be suffering from new-onset diabetes as compared to females with DKA (30% vs. 15.8%, respectively). Most of these males with DKA who presented with New Onset Diabetes had New Onset type-1 Diabetes (24.2%). Since DKA in adult-onset type 1 diabetes is a late complication [ 15 ], it is concerning to see a significantly higher proportion of males with DKA having New-Onset Diabetes. Since adult males in our population with late-onset type 1 and type 2 DM are more likely to remain undiagnosed and present with more severe complications, i.e., DKA, early screening and treatment of males having risk factors for DM would be prudent. Patients of both genders had uncontrolled diabetes with high HBA1C values (11.6 ± 3 vs 11.3 ± 2.7 for males and females, respectively). In addition, history of previous episodes of DKA was significantly higher in females (11.4%) compared to males (4.2%). Due to the constraints of the milieu of women in Pakistan, taking care of the family takes precedence over caring for themselves, which could explain this disparity [ 13 , 14 ]. Therefore, all patients with uncontrolled DM, especially women, at risk of complications require particular attention and should be counseled regarding developing and preventing complications. They should be routinely monitored, and if needed, treatment should be intensified early to prevent severe complications like DKA. The clinical presentation significantly differed in assessing altered mental status among the two groups. According to our data, higher percentages of males suffering from DKA were seen to have mild or severely altered mental status compared to females. Most female patients presented with moderately altered mental status. The difference in males having severely altered mental status in a significantly higher proportion than females (24.2% vs. 13.2% respectively) correlates with the substantially higher serum osmolality in males (309.1 ± 29.6) in contrast to females (298.6 ± 25.2). This confirms the previous literature, which attributes the depressed sensorium to elevated serum osmolality in synergism with acidosis in patients with DKA [ 16 , 17 ]. Hemoglobin is physiologically different in males and females and, therefore, also appeared so in our study population. However, Cr and BUN were significantly higher in males compared to females, which correlates with the high proportion of renal dysfunction in males with DKA compared to females. Amylase titer was significantly higher in the female patients, ostensibly since most patients presenting with pancreatitis being the precipitating symptom (others) in our study population were women compared to men. No significant differences were found regarding age, BMI, family, previous comorbid, oral hypoglycemic (OHAs) and insulin therapy, duration of DM, signs, symptoms, and severity of DKA, remaining biochemical profile, precipitating factors, and outcomes. The findings of this study are limited by the fact that it is a retrospective study carried out in a single tertiary care center with a short duration of 5 years. Conclusions Considering our findings, since adult males in our population are more likely to present with New Onset type 1 and type 2 DM and are more likely to present with more severe complications, preventive measures aimed at males with risk factors for DM are needed. At the same time, educational programs for both genders are required to inform and counsel regarding the complications of uncontrolled DM adequately. To devise such plans, further studies need to be carried out in more centers so that recommendations at a national level can be implemented. Declarations Ethics approval and consent to participate: The study was approved by the Ethics Review Committee of the Aga Khan University Hospital (number: 3649-med-ERC-15). Consent was waived because the data was retrieved from the records without any identifying information. Consent for publication: Not applicable. Availability of data and materials: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request, while the tables generated are included in the article. Competing interests: The authors declare that they have no competing interests. Funding: This study received no financial support. Contributions: The authors contributed equally to this work. Acknowledgements: Not applicable References Freire AX, Umpierrez GE, Afessa B, Latif KA, Bridges L, Kitabchi AE. Predictors of intensive care unit and hospital length of stay in diabetic ketoacidosis. Journal of critical care. 2002 Dec 1;17(4):207-11. Umpierrez GE, Murphy MB, Kitabchi AE. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Diabetes spectrum. 2002 Jan 1;15(1):28-36. Azevedo LC, Choi H, Simmonds K, Davidow J, Bagshaw SM. Incidence and long-term outcomes of critically ill adult patients with moderate-to-severe diabetic ketoacidosis: retrospective matched cohort study. Journal of critical care. 2014 Dec 1;29(6):971-7. Chiasson JL, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ékoé JM, Fournier H, Havrankova J. Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Cmaj. 2003 Apr 1;168(7):859-66. Bull SV, Douglas IS, Foster M, Albert RK. Mandatory protocol for treating adult patients with diabetic ketoacidosis decreases intensive care unit and hospital lengths of stay: results of a nonrandomized trial. Critical care medicine. 2007 Jan 1;35(1):41-6. Barski L, Nevzorov R, Jotkowitz A, Rabaev E, Zektser M, Zeller L, Shleyfer E, Harman-Boehm I, Almog Y. Comparison of diabetic ketoacidosis in patients with type-1 and type-2 diabetes mellitus. The American journal of the medical sciences. 2013 Apr 1;345(4):326-30. Newton CA, Raskin P. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-3824590\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":265189588,\"identity\":\"569fb5da-e2ef-4408-8648-9a28a6d4c067\",\"order_by\":0,\"name\":\"Abdus Salam\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Khyber Teaching Hospital\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Abdus\",\"middleName\":\"\",\"lastName\":\"Salam\",\"suffix\":\"\"},{\"id\":265189589,\"identity\":\"4081e0d0-c452-4bca-b54b-69ae83bfc878\",\"order_by\":1,\"name\":\"Yasir 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Houston\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Muhammad\",\"middleName\":\"Salman\",\"lastName\":\"Khan\",\"suffix\":\"\"},{\"id\":265189595,\"identity\":\"4525c7e0-107f-4a22-bb4a-1f6011617157\",\"order_by\":7,\"name\":\"Najmul Islam\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Aga Khan University Hospital\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Najmul\",\"middleName\":\"\",\"lastName\":\"Islam\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2023-12-30 17:44:14\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-3824590/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-3824590/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":49241376,\"identity\":\"1a1275db-9088-4f17-8b3f-5350fb3cdb31\",\"added_by\":\"auto\",\"created_at\":\"2024-01-05 18:24:40\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":81110,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eBar chart showing Type of Diabetes Mellitus (DM) in patients with Diabetic Ketoacidosis (DKA)\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3824590/v1/4927b552067b628f25d59310.png\"},{\"id\":50212385,\"identity\":\"c012ecc5-f23d-4afd-9a38-c4178738a535\",\"added_by\":\"auto\",\"created_at\":\"2024-01-26 12:07:26\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":360783,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3824590/v1/cd0ae275-d0ea-48b9-bce3-9e21f922be61.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Gender Related Differences in Clinical Presentation and Outcomes of Diabetic Ketoacidosis: A Retrospective Study\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eDiabetic Ketoacidosis (DKA) is an acute emergency caused by an abnormal imbalance of insulin deficiency and catecholamines/glucagon, resulting in problems like hyperglycemia, metabolic acidosis, and ketosis [\\u003cspan additionalcitationids=\\\"CR2\\\" citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e–\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. It is a well-known complication of Diabetes Mellitus (DM) resulting in significant morbidity, mortality, and a remarkable burden on healthcare resources. 9 to 28% of all diabetes-related admissions have been ascribed to DKA [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. There are more than 10000 annual hospital admissions for DKA in the United States of America and between 5000 to 10000 in Canada [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. Previously it was believed that DKA occurs mainly in patients with type 1 DM. However, patients with type 2 DM are prone to develop DKA under stressful conditions such as infections, surgery, or trauma [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. According to the literature, the prevalence of type 2 DM is higher than type 1 DM, and the proportion is expected to increase with time; therefore, the presentation of DKA is likely to be higher in patients with type 2 DM, and this might explain the increased hospitalization for DKA [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. Many studies have been conducted to observe the characteristics of DKA in both type 1 and type 2 DM [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e–\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. However, little is known about differences in the clinical features and outcomes of patients with DKA concerning gender. Since local data regarding DKA in Pakistan has been very scarce [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e], no studies have been done to elucidate the differences in the clinical features and outcomes of patients with DKA in relation to gender.\\u003c/p\\u003e \\u003cp\\u003eConsequently, there needs to be more knowledge regarding this disorder's proper diagnosis, prevention, and management [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. In this study, we aimed to investigate whether there were gender-related differences in the clinical presentation and outcomes of DKA patients who were admitted through the Emergency Room (ER) at the Aga Khan University Hospital (AKUH). The diverse socio-economic backgrounds of patients presenting to the AKUH provided a study sample representative of the Pakistani population.\\u003c/p\\u003e \"},{\"header\":\"Materials \\u0026 Methods\",\"content\":\"\\u003cp\\u003e We conducted this retrospective, descriptive study at the Aga Khan University Hospital (AKUH), a tertiary care hospital in Karachi, Pakistan. The duration of this study was five years, i.e., from July 2016 to July 2020. The Ethics Review Committee of the institution approved the study. No personal details by any means related to any patient were revealed regarding ethical considerations. Data of all patients aged more than 16 years and presenting with DKA to the emergency department of AKUH was reviewed, and their clinical and biochemical parameters were noted. Patients aged below 16 years and non-diabetics presenting with ketoacidosis were excluded from the study. Computer coding was used to identify admissions with an ICD code for DM and DKA for five years. Diagnostic criteria of the American Diabetes Association (ADA) were used.\\u003c/p\\u003e\\u003cp\\u003eThe diagnosis of DKA was made by the presence of an arterial pH lower than 7.30, an anion gap of less than 15 mmol/L, hyperglycemia, i.e., blood glucose \\u0026gt; 250mg/dL, and urine ketone levels of 'moderate' or 'large,' i.e., equal to or more than 2 + or ketonemia measured in the lab. DKA was classified as mild, moderate, or severe according to ADA criteria. Serum osmolality was calculated using the formula, i.e., 2{measured Na + (mEq/l)} + glucose(mg/dl)/18 + (Blood Urea Nitrogen (BUN) / 2.8) and was measured in mosm/kg. Anion gap was calculated using the formula, i.e., {(Na +) − (Cl - + HCO3 -)} (mEq/L). Data was collected for males and females through a questionnaire filled out for the sample population by the data analyst, a team member. Information regarding patient demographics, presenting symptoms, precipitating causes of DKA, vital signs, biochemical profiles at presentation to the emergency department, time from presentation to resolution of urine ketones, insulin dose at discharge, length of hospitalization, and outcome at discharge were collected. Precipitating factors of DKA were defined as conditions leading to the development of DKA, such as inadequate insulin doses or missed insulin doses, sepsis, infection, and surgical stress. For patients presenting with more than one factor, the leading cause was noted. Observation bias was controlled by reconfirmation of collected information from the hospital's records by a second verifier. Confounding factors were rectified through restriction. Patients were classified as Type 2 DM if they had a prior history of treatment (\\u0026gt; one year) with diet alone or oral hypoglycemic agents (OHA) or as 'new onset' if the episode of DKA was the first manifestation of diabetes. Patients with new-onset DM were then further classified as type 1 or Type 2 after autoimmune profile results or if they discontinued insulin use without recurrence of DKA for at least one year, respectively. Patient follow-up data were obtained by chart review or telephone contact when necessary. Precipitating factors of DKA were defined as conditions leading to the development of DKA, based on physicians' diagnosis and information obtained from the patient's medical record, like inadequate insulin dose or missed insulin doses, sepsis, any other infection, surgical stress, etc. For patients presenting with more than one factor, the leading cause was accounted. The demographic parameters included gender, age, height, and BMI. Data was analyzed using the SPSS 20 software. Frequency and percentages were computed for categorical variables, i.e., type and duration of DM, previous episode of DKA, presenting symptoms, and severity of DKA. Mean and Standard Deviation were computed for continuous variables, i.e., age, BMI, and biochemical parameters. We used the independent Sample-T test to compare the means of discrete variables of male and female patients. Clustered Bar Chart was obtained for significant categorical variables. We applied the chi-square test to identify significant differences.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eTwo hundred thirty-four patients were identified to be admitted with the diagnosis of DKA at AKUH in the mentioned five years. 120 (51.3%) were males (mean age\\u0026thinsp;=\\u0026thinsp;46.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;16.6), and 114 (48.7%) were females (mean age\\u0026thinsp;=\\u0026thinsp;44\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;18.8). The comparison of the type of diabetes and patients\\u0026rsquo; characteristics between the two groups showed significant differences in the previous episodes of DKA. Female patients had a higher chance of having a history of previous episodes of DKA compared to males (13.4% vs. 4.2%, respectively [p-value: 0.047]). There was a significant difference in the type of diabetes between the two DKA groups (p\\u0026thinsp;=\\u0026thinsp;0.036). Male patients had a significantly higher proportion of New Onset type 1 (24.2%) and New Onset type 2 (5.8%) at presentation, as compared to female patients in whom the percentage of New Onset type1 and type 2 was only 14.0% and 1.8% (Table \\u003cspan\\u003e1\\u003c/span\\u003e), (Fig. 1).\\u003c/p\\u003e\\n\\u003cdiv\\u003e\\u0026nbsp;\\u003ctable id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv\\u003eTable 1\\u003c/div\\u003e\\n \\u003cdiv\\u003e\\n \\u003cp\\u003eDemographics and Past History at the time of presentation to the hospital in Patients with Diabetic Ketoacidosis.\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003ccolgroup cols=\\\"5\\\"\\u003e\\u003c/colgroup\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eVariables\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eGender\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eP - Value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNumber of patients (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e120(51.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e114(48.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAge (years)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e46.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;16.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e44\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;18.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.21\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBMI (kg/m\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e23.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e23.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eComorbidity present\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e58(48.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e54(47.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.883\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePrevious episodes of DKA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5(4.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e13(11.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.047\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOral Hypoglycemic Agents Therapy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e37(30.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e29(25.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.275\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eInsulin Therapy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e49(40.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e48(42.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.168\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"4\\\"\\u003e\\n \\u003cp\\u003eDuration of Diabetes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLess than 1 year\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5(6.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e7(9.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"4\\\"\\u003e\\n \\u003cp\\u003e0.190\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1 to 5 years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e12(16.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e22(28.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e6 to 10 years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e19(25.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e18(23.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003emore than 10 years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e39(52.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e29(38.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"7\\\"\\u003e\\n \\u003cp\\u003eCormibidities\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHypertension\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e15(12.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e20(17.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"7\\\"\\u003e\\n \\u003cp\\u003e0.512\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eIschemic Heart Disease\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e11(9.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4(3.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eChronic Kidney Disease\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e9(7.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e6(5.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHypothyroidism\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5(4.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e8(7.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eChronic Liver Disease\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e6(5.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4(3.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMalignancy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e6(5.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4(3.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOthers\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e6(5.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e8(7.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"4\\\"\\u003e\\n \\u003cp\\u003eType of Diabetes mellitus Present\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNew Onset Type I\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e29(24.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e16(14.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"4\\\"\\u003e\\n \\u003cp\\u003e0.036\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eKnown Type I\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e23(19.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e34(29.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eKnown Type II\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e61(50.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e62(54.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNe Onset Type II\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e7(5.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2(1.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003e[Data presented as Mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;Standard Deviation and n (percent)]\\u003c/p\\u003e\\n\\u003cp\\u003eThere was no significant difference in most presenting symptoms among the Male and Female groups. Nevertheless, more male patients presented with severely altered mental status (24.2%) than female DKA patients (13.2%) (p-value: 0.005). (Table \\u003cspan\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e\\n\\u003cdiv\\u003e\\u0026nbsp;\\u003ctable id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv\\u003eTable 2\\u003c/div\\u003e\\n \\u003cdiv\\u003e\\n \\u003cp\\u003eSigns and Symptoms, Altered mental status and severity of Diabetic Ketoacidosis (DKA) in patients with DKA\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003ccolgroup cols=\\\"5\\\"\\u003e\\u003c/colgroup\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eVariables\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eGender\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eP-Value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMale(120)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale(114)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"9\\\"\\u003e\\n \\u003cp\\u003eSigns and Symptoms\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePolyuria\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e19(15.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e22(19.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.486\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePolydipsia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e17(14.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e19(16.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.596\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePolyphagia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e8(6.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e7(6.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.869\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eWeight Loss\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e11(9.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e9(7.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.728\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNausea\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e13(10.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e19(16.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.194\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVomiting\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e48(40%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e59(51.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.071\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAbdominal pain\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e31(25.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e41(36%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.093\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDiarrhea\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e17(14.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e14(12.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.671\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFits\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5(4.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1(0.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.112\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003eAltered mental status\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMild\\u0026thinsp;=\\u0026thinsp;Alert\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e39(32.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e26(22.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003e0.005\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eModerate\\u0026thinsp;=\\u0026thinsp;Alert /drowsy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e52(43.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e73(64.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSevere\\u0026thinsp;=\\u0026thinsp;Stupor/coma\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e29(24.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e15(13.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003eSeverity of DKA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMild DKA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e40(33.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e37(32.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003e0.296\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eModerate DKA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e69(57.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e59(51.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSevere DKA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e11(9.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e18(15.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eThe most common precipitating factors in both genders were Infections and medication noncompliance, but there was no significant statistical difference between the two groups (Table \\u003cspan\\u003e3\\u003c/span\\u003e).\\u003c/p\\u003e\\n\\u003cdiv\\u003e\\u0026nbsp;\\u003ctable id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv\\u003eTable 3\\u003c/div\\u003e\\n \\u003cdiv\\u003e\\n \\u003cp\\u003eMost common precipitating factors in patients with Diabetic Ketoacidosis (DKA)\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003ccolgroup cols=\\\"4\\\"\\u003e\\u003c/colgroup\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003ePrecipitating Factors\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eGender\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eP \\u0026ndash; Value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMale (120)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale(114)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eInfections\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e41(34.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e44(38.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"7\\\"\\u003e\\n \\u003cp\\u003e0.532\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNoncompliance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e23(19.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e17(14.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMyocardial Infarction\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e8(6.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3(2.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStroke\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3(2.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2(1.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePost-surgery\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3(2.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3(2.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSteroid Induced\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2(1.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3(2.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOthers\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e36(30.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e31(27.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eSignificant differences were seen in the biochemical findings of male and female DKA patients (Table \\u003cspan\\u003e4\\u003c/span\\u003e). The higher biochemical markers in males included Hemoglobin (13.1 vs. 12.2 [p-value: 0.008]), BUN 35.7 vs. 27.6 [p-value: 0.016]), Creatinine (2.3 vs. 1.6 [p-value: 0.006]), and serum osmolality (309 vs. 298.6 [p-value: 0.004], while Amylase was significantly higher in females (278 vs. 139 [p-value: 0.05]).\\u003c/p\\u003e\\n\\u003cdiv\\u003e\\u0026nbsp;\\u003ctable id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv\\u003eTable 4\\u003c/div\\u003e\\n \\u003cdiv\\u003e\\n \\u003cp\\u003eBiochemical profile at the time of presentation to the hospital in patients with Diabetic Ketoacidosis (DKA)\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003ccolgroup cols=\\\"5\\\"\\u003e\\u003c/colgroup\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eVariables\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eGender\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eP-Value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eHemoglobin(gm/dl)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e13.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e12.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.008\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eWBC Count (x10E9/L)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e15.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e16.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.821\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003ePlatelet Count (x10E9/L)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e296\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;152.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e306.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;130.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.594\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eBUN(mg/dl)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e35.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;25.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e27.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;25.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.016\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eCreatinine(mg/dl)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.006\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eSodium(mmol/L)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e132.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e131\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.183\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003ePotassium(mm/L)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.503\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eChloride (mmol/L)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e97.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e97.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.799\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eBicarbonate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.877\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eArterial pH\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e7.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e7.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.123\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003epCO2(mmHg)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e24\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e23.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.388\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003epO2(mmHg)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e119.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;81.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e123.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;72.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.730\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eAmylase\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e139.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;181\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e278.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;416.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.05\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eLipase\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e107.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;122\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e231.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;491\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.106\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eUrinary ketones\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.434\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eRandom Blood Sugar\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e499.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;172.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e488\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;206.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.648\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eSerum Osmolality (mOsm/Kg)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e309\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;29.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e298.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;25.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.004\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eAnion Gap\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e24.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e23.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.491\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eHbA1C\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e11.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e11.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.609\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003eUrinary Ketones\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1 positive\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3(2.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e9(7.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003e0.131\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2 positive\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e47(39.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e37(32.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3 positive\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e70(58.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e68(59.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eInterestingly, there were no significant differences in the outcomes of the DKA between the two groups, including mortality, total length of stay, Intensive Care Unit (ICU) stay, or requirement of ventilatory support (Table \\u003cspan\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e\\n\\u003cdiv\\u003e\\u0026nbsp;\\u003ctable id=\\\"Tab5\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv\\u003eTable 5\\u003c/div\\u003e\\n \\u003cdiv\\u003e\\n \\u003cp\\u003eOutcomes in Patients with Diabetic Ketoacidosis (DKA)\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003ccolgroup cols=\\\"5\\\"\\u003e\\u003c/colgroup\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eOutcomes\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eGender\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eP - Value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMortality\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e13(10.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e9(7.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.441\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"4\\\"\\u003e\\n \\u003cp\\u003eLength of hospital Stay\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLess than 5 days\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e69(57.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e75(65.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" rowspan=\\\"4\\\"\\u003e\\n \\u003cp\\u003e0.601\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5 to 10 days\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e31(25.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e24(21.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10\\u0026ndash;15 days\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e12(10.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e10(8.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMore than 15 days\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e8(6.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e5(4.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eIntensive Care Unit (ICU) Stay\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e34(28.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e31(27.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.846\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVentilator Support\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e32(26.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e26(22.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.494\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003ePrevious studies have shown that even though the ratio of men to women afflicted with Diabetes Mellitus is roughly equal, the risk of DKA in women is different from men [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. Some studies reported that women have a 50% higher risk of developing DKA than men. Leonid Barski et al. recorded that most patients with DKA were females (59.5%), confirming the previous literature [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. However, in our study population, a high percentage of patients with DKA was found to be males (51.3%), as opposed to the previous studies that found a high tendency of DKA in female patients [\\u003cspan additionalcitationids=\\\"CR10\\\" citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. Moreover, the high female-to-male ratio is falling with a reduction in the number of episodes occurring in female patients and an increase in the number of episodes occurring in male patients, particularly among those patients with recurrent episodes of DKA [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. In our study, males with DKA were more likely to be suffering from new-onset diabetes as compared to females with DKA (30% vs. 15.8%, respectively). Most of these males with DKA who presented with New Onset Diabetes had New Onset type-1 Diabetes (24.2%). Since DKA in adult-onset type 1 diabetes is a late complication [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e], it is concerning to see a significantly higher proportion of males with DKA having New-Onset Diabetes. Since adult males in our population with late-onset type 1 and type 2 DM are more likely to remain undiagnosed and present with more severe complications, i.e., DKA, early screening and treatment of males having risk factors for DM would be prudent.\\u003c/p\\u003e \\u003cp\\u003ePatients of both genders had uncontrolled diabetes with high HBA1C values (11.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3 vs 11.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.7 for males and females, respectively). In addition, history of previous episodes of DKA was significantly higher in females (11.4%) compared to males (4.2%). Due to the constraints of the milieu of women in Pakistan, taking care of the family takes precedence over caring for themselves, which could explain this disparity [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. Therefore, all patients with uncontrolled DM, especially women, at risk of complications require particular attention and should be counseled regarding developing and preventing complications. They should be routinely monitored, and if needed, treatment should be intensified early to prevent severe complications like DKA.\\u003c/p\\u003e \\u003cp\\u003eThe clinical presentation significantly differed in assessing altered mental status among the two groups. According to our data, higher percentages of males suffering from DKA were seen to have mild or severely altered mental status compared to females. Most female patients presented with moderately altered mental status. The difference in males having severely altered mental status in a significantly higher proportion than females (24.2% vs. 13.2% respectively) correlates with the substantially higher serum osmolality in males (309.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;29.6) in contrast to females (298.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;25.2). This confirms the previous literature, which attributes the depressed sensorium to elevated serum osmolality in synergism with acidosis in patients with DKA [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eHemoglobin is physiologically different in males and females and, therefore, also appeared so in our study population. However, Cr and BUN were significantly higher in males compared to females, which correlates with the high proportion of renal dysfunction in males with DKA compared to females. Amylase titer was significantly higher in the female patients, ostensibly since most patients presenting with pancreatitis being the precipitating symptom (others) in our study population were women compared to men.\\u003c/p\\u003e \\u003cp\\u003eNo significant differences were found regarding age, BMI, family, previous comorbid, oral hypoglycemic (OHAs) and insulin therapy, duration of DM, signs, symptoms, and severity of DKA, remaining biochemical profile, precipitating factors, and outcomes.\\u003c/p\\u003e \\u003cp\\u003eThe findings of this study are limited by the fact that it is a retrospective study carried out in a single tertiary care center with a short duration of 5 years.\\u003c/p\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003eConsidering our findings, since adult males in our population are more likely to present with New Onset type 1 and type 2 DM and are more likely to present with more severe complications, preventive measures aimed at males with risk factors for DM are needed. At the same time, educational programs for both genders are required to inform and counsel regarding the complications of uncontrolled DM adequately. To devise such plans, further studies need to be carried out in more centers so that recommendations at a national level can be implemented.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study was approved by the Ethics Review Committee of the Aga Khan University Hospital (number: 3649-med-ERC-15). Consent was waived because the data was retrieved from the records without any identifying information.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request, while the tables generated are included in the article.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study received no financial support.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eContributions:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors contributed equally to this work.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eFreire AX, Umpierrez GE, Afessa B, Latif KA, Bridges L, Kitabchi AE. Predictors of intensive care unit and hospital length of stay in diabetic ketoacidosis. Journal of critical care. 2002 Dec 1;17(4):207-11.\\u003c/li\\u003e\\n\\u003cli\\u003eUmpierrez GE, Murphy MB, Kitabchi AE. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Diabetes spectrum. 2002 Jan 1;15(1):28-36.\\u003c/li\\u003e\\n\\u003cli\\u003eAzevedo LC, Choi H, Simmonds K, Davidow J, Bagshaw SM. Incidence and long-term outcomes of critically ill adult patients with moderate-to-severe diabetic ketoacidosis: retrospective matched cohort study. Journal of critical care. 2014 Dec 1;29(6):971-7.\\u003c/li\\u003e\\n\\u003cli\\u003eChiasson JL, Aris-Jilwan N, B\\u0026eacute;langer R, Bertrand S, Beauregard H, \\u0026Eacute;ko\\u0026eacute; JM, Fournier H, Havrankova J. Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Cmaj. 2003 Apr 1;168(7):859-66.\\u003c/li\\u003e\\n\\u003cli\\u003eBull SV, Douglas IS, Foster M, Albert RK. Mandatory protocol for treating adult patients with diabetic ketoacidosis decreases intensive care unit and hospital lengths of stay: results of a nonrandomized trial. Critical care medicine. 2007 Jan 1;35(1):41-6.\\u003c/li\\u003e\\n\\u003cli\\u003eBarski L, Nevzorov R, Jotkowitz A, Rabaev E, Zektser M, Zeller L, Shleyfer E, Harman-Boehm I, Almog Y. Comparison of diabetic ketoacidosis in patients with type-1 and type-2 diabetes mellitus. The American journal of the medical sciences. 2013 Apr 1;345(4):326-30.\\u003c/li\\u003e\\n\\u003cli\\u003eNewton CA, Raskin P. Diabetic ketoacidosis in type 1 and type 2 diabetes mellitus: clinical and biochemical differences. Archives of internal medicine. 2004 Sep 27;164(17):1925-31.\\u003c/li\\u003e\\n\\u003cli\\u003eUmpierrez GE, Kelly JP, Navarrete JE, Casals MM, Kitabchi AE. Hyperglycemic crises in urban blacks. Archives of internal medicine. 1997 Mar 24;157(6):669-75.\\u003c/li\\u003e\\n\\u003cli\\u003eYamada K, Nonaka K. Diabetic ketoacidosis in young obese Japanese men. Diabetes Care. 1996 Jun 1;19(6):671-671.\\u003c/li\\u003e\\n\\u003cli\\u003eBalasubramanyam A, Zern JW, Hyman DJ, Pavlik V. New profiles of diabetic ketoacidosis: type 1 vs type 2 diabetes and the effect of ethnicity. Archives of internal medicine. 1999 Oct 25;159(19):2317-22.\\u003c/li\\u003e\\n\\u003cli\\u003eJabbar A, Farooqui K, Habib A, Islam N, Haque N, Akhter J. Clinical characteristics and outcomes of diabetic ketoacidosis in Pakistani adults with Type 2 diabetes mellitus. Diabetic medicine. 2004 Aug;21(8):920-3.\\u003c/li\\u003e\\n\\u003cli\\u003eBarski L, Harman-Boehm I, Nevzorov R, Rabaev E, Zektser M, Jotkowitz AB, Zeller L, Shleyfer E, Almog Y. Gender-related differences in clinical characteristics and outcomes in patients with diabetic ketoacidosis. Gender medicine. 2011 Dec 1;8(6):372-7.\\u003c/li\\u003e\\n\\u003cli\\u003eWright AD, Hale PJ, Singh BM, Kilvert JA, Nattrass M, FitzGerald MG. Changing sex ratio in diabetic ketoacidosis. Diabetic medicine. 1990 Aug;7(7):628-32.\\u003c/li\\u003e\\n\\u003cli\\u003eLegato MJ, Gelzer A, Goland R, Ebner SA, Rajan S, Villagra V, Kosowski M. Gender-specific care of the patient with diabetes: review and recommendations. Gender medicine. 2006 Jun 1;3(2):131-58.\\u003c/li\\u003e\\n\\u003cli\\u003eNadhem O, Nakhla E, Smalligan RD. Diabetic ketoacidosis as first presentation of latent autoimmune diabetes in adult. Case Reports in Medicine. 2015 Mar 5;2015.\\u003c/li\\u003e\\n\\u003cli\\u003eFulop M, Rosenblatt A, Kreitzer SM, Gerstenhaber B. Hyperosmolar nature of diabetic coma. Diabetes. 1975 Jun 1;24(6):594-9.\\u003c/li\\u003e\\n\\u003cli\\u003eNyenwe EA, Razavi LN, Kitabchi AE, Khan AN, Wan JY. Acidosis: the prime determinant of depressed sensorium in diabetic ketoacidosis. Diabetes care. 2010 Aug 1;33(8):1837-9.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Diabetic Ketoacidosis, Diabetes, Gender difference\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-3824590/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-3824590/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground\\u003c/strong\\u003e: Diabetic Ketoacidosis (DKA) is a well-known complication of Diabetes Mellitus (DM). Many studies have been conducted to observe the characteristics of DKA in both type 1 and type 2 DM. However, little is known about differences in the clinical features and outcomes of patients with DKA in relation to gender. In this study, we aimed to investigate whether there were any gender-related differences in the clinical presentation and outcomes of DKA patients. \\u003cstrong\\u003eMethodology\\u003c/strong\\u003e: We conducted this retrospective, descriptive study at the Aga Khan University Hospital (AKUH) Karachi, Pakistan, from July 2016 to July 2020. Data of patients above 16 years of age presented to the emergency department with DKA was reviewed. Information was collected regarding patient demographics, presenting symptoms, precipitating causes of DKA, vital signs, biochemical profiles, and outcomes at discharge.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e: Of 234 patients, 120 (51.3%) were males (mean age=46.8±16.6), and 114 (48.7%) were females (mean age=44±18.8). Our results showed that females had a higher chance of having previous episodes of DKA (13.4% vs. 4.2%) than males (p=0.047). There was a higher proportion of New Onset type 1 (24.2%) and New Onset type 2 (5.8%) Diabetes at presentation in male patients, as compared to female patients (14.0 and 1.8%, respectively). More male patients presented with severely altered mental status (24.2%) than female patients (13.2%). The higher biochemical markers in males included Hemoglobin, BUN, Creatinine, and serum osmolality, while Amylase was significantly higher in females. Finally, there were no significant differences in the outcomes between the two groups.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion\\u003c/strong\\u003e: As male patients in our population are more likely to present with New Onset type DM and are more likely to present with severe complications, preventive measures targeting male patients with risk factors for DM are paramount. Moreover, educational programs for both genders regarding complications and prevention are required. In order to form such plans, further studies at more centers need to be carried out so recommendations at a national level can be implemented.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Gender Related Differences in Clinical Presentation and Outcomes of Diabetic Ketoacidosis: A Retrospective Study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-01-05 18:24:35\",\"doi\":\"10.21203/rs.3.rs-3824590/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"01abca54-4d01-4704-9df0-375f28727571\",\"owner\":[],\"postedDate\":\"January 5th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-01-26T11:59:16+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-01-05 18:24:35\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-3824590\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-3824590\",\"identity\":\"rs-3824590\",\"version\":[\"v1\"]},\"buildId\":\"7rjqhiLT3MXkJMwkYKINL\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}