diabetes and dka are common in the nepalese population . no study has been done to know the clinical profile and outcomes of dka patients . hence , the aim of this study was to determine the pattern of dka at a teaching hospital in b. p. koirala institute of health sciences , dharan , to assess the clinical and biochemical characteristics of the patients and the precipitating factors for dka . all consecutive patients diagnosed with dka admitted in medical ward from january 2010 to december 2010 defined by american diabetes association ( ada ) 2006 consensus statement : we diagnosed the patient on the basis of clinical features and age and presence or absence of ketone bodies and response to insulin treatment . we do not have facility of gad antibody in our hospital , c - peptide or insulin level in our hospital . typical clinical features such as hyperventilation , vomiting , and dehydration with : 
 hyperglycemia 250 mg / dlarterial blood ph 7.3serum bicarbonate 18 mmol / lpresence of ketonuria ( 2 + on dipstick ) . hyperglycemia 250 mg / dl arterial blood ph 7.3 serum bicarbonate 18 mmol / l presence of ketonuria ( 2 + on dipstick ) . severity of dka was defined according to ada criteria 2006 : 
 mild ( arterial blood ph 7.257.30)moderate ( ph 7.007.24 ) orsevere ( ph < 7.00 ) . mild ( arterial blood ph 7.257.30 ) moderate ( ph 7.007.24 ) or effective osmolarity was calculated using the ada formula : ( [ 2  sodium ] + plasma glucose/18 ) , with normal values being 290 mmol / kg water . the following variables were recorded : age , sex , nationality , duration of diabetes , precipitating factors for dka , duration of symptoms before seeking medical advice , clinical features , laboratory findings at presentation with dka ( plasma glucose , serum blood urea nitrogen , serum creatinine , serum sodium and potassium , urine acetone , arterial blood ph , plasma bicarbonate , and plasma osmolarity ) , associated complications , duration of hospitalization and outcome . patients were classified as having type 1 or type 2 diabetes based on their treatment history . the mean rbs and bicarbonate at presentation were 451.25  115.827 and 13.769  5.2240 respectively with osmolality at presentation 347.41  98.28 . clinical and biochemical profiles among the patients at presentation the data were analyzed using spss , version 11.0 ( ibm corp ) . differences between groups were tested statistically using the chi - squared test and independent samples t - test . all consecutive patients diagnosed with dka admitted in medical ward from january 2010 to december 2010 defined by american diabetes association ( ada ) 2006 consensus statement : we diagnosed the patient on the basis of clinical features and age and presence or absence of ketone bodies and response to insulin treatment . we do not have facility of gad antibody in our hospital , c - peptide or insulin level in our hospital . typical clinical features such as hyperventilation , vomiting , and dehydration with : 
 hyperglycemia 250 mg / dlarterial blood ph 7.3serum bicarbonate 18 mmol / lpresence of ketonuria ( 2 + on dipstick ) . hyperglycemia 250 mg / dl arterial blood ph 7.3 serum bicarbonate 18 mmol / l presence of ketonuria ( 2 + on dipstick ) . severity of dka was defined according to ada criteria 2006 : 
 mild ( arterial blood ph 7.257.30)moderate ( ph 7.007.24 ) orsevere ( ph < 7.00 ) . 
  mild ( arterial blood ph 7.257.30 ) moderate ( ph 7.007.24 ) or effective osmolarity was calculated using the ada formula : ( [ 2  sodium ] + plasma glucose/18 ) , with normal values being 290 mmol / kg water . the following variables were recorded : age , sex , nationality , duration of diabetes , precipitating factors for dka , duration of symptoms before seeking medical advice , clinical features , laboratory findings at presentation with dka ( plasma glucose , serum blood urea nitrogen , serum creatinine , serum sodium and potassium , urine acetone , arterial blood ph , plasma bicarbonate , and plasma osmolarity ) , associated complications , duration of hospitalization and outcome . patients were classified as having type 1 or type 2 diabetes based on their treatment history . the mean rbs and bicarbonate at presentation were 451.25  115.827 and 13.769  5.2240 respectively with osmolality at presentation 347.41  98.28 . clinical and biochemical profiles among the patients at presentation the data were analyzed using spss , version 11.0 ( ibm corp ) . differences between groups were tested statistically using the chi - squared test and independent samples t - test . only 16 patients ( seven type 1 and nine type 2 dm ) were with dka . the males to female ratio were ( 1:1.3 in type 1 dm and 1:1.25 ) of all dka admission . our study showed the age of the patients ranged between 25 and 72 years , with an average of 48.2 years . the maximum number of cases was found between 56.89  14.76 years in type 2 diabetes and 25  7.9 years in type 1 diabetes . the mean body mass index was 20.5  2.44 in both type 1 and type 2 dm . five were on oral hypoglycemic agents ( oha ) and three on both ( insulin and oha ) . the approximate duration of dka prior to hospital admission was significantly higher in type 2 dm than type 1 dm ( 9  0.527 vs 7  0.1 years , p = 0.044 ) . the significant difference between the range of biochemical alterations on admission was seen more in type 2 dm than type 1 dm ( urea , mg / dl 31.14  19.403 vs 69  43.578 , p = 0.05 and arterial ph 7.11  0.204 vs 7.28  0.1180.04 , p = 0.04 ) . most of the patients had a history of diabetes for < 5 years and both type 1 and type 2 dm . infection was most common precipitating factor ( 56.25% ) more in type 1 dm than type 2 dm followed by poor drug compliance ( 37.5% ) more in type 2 dm than type 1 dm and first presentation ( 6.25% ) . the average length of hospitalization was slightly longer in type 2 dm patients than in the type 1 dm patients ( 60 days vs. 10 days ; p = 0.04 ) [ figure 1 ] . most of the patents had average duration of diabetes less than 5 years n both type1 and type 2 diabetes [ figure 2 ] . precipitating factors of diabetic ketoacidosis among type 1 and type 2 dm duration of diabetes in type 1 and type 2 dm diabetic ketoacidosis is a serious and preventable acute complication of diabetes mellitus which has been declining in recent years . in our study , males were predominant in both type 1 and type 2 dm of all dka admission . whereas roaeid and kablan , had female less than male and el - sharief reported a nearly equal ratio of sexes in tripoli . we think that the cause of these variations is multifactorial , including environmental , genetic , and social differences . patients with t2 dm were significantly older than those with t1 dm ( which is similar to study done by edo ae . the reason might be due to significant / physical stress ( other than the effects of persistent hyperglycemia per se ) is a prerequisite for patients with type 2 diabetes to develop dka . in our study , infection was the most common precipitating factor ( 56.25% ) followed by poor drug compliance ( 37.5% ) and first presentation ( 6.25% ) which were similar to study done by matoo et al . therefore , dka should be considered in patients with diabetes who have a concurrent infection , stroke , myocardial infarction , or other serious illness and should be treated aggressively . despite the small sample size of this study , and the fact that it was a hospital - based prospective study conducted at a teaching hospital , all of which are important limitations , this study gives a basic profile of dka in this part of the world where studies about dka are few . despite the small sample size of this study , and the fact that it was a hospital - based prospective study conducted at a teaching hospital , all of which are important limitations , this study gives a basic profile of dka in this part of the world where studies about dka are few . we found majority of patients had type 2 dm ( 31.25% ) presenting with moderate type dka . metabolic acidosis and increased serum urea had a significant association in both types of diabetes . infection was the most common precipitating factor ( 56.25% ) followed by poor drug compliance ( 37.5% ) .
introduction : diabetes ketoacidoisis ( dka ) is characterized by hyperketonaemia , metabolic acidosis , and hyperglycemia . 
 aims : the aim of this study was to describe the demographic profile , clinical characterstics of patients admitted with diabetic ketoacidosis in bpkihs , medical ward.settings and design : the hospital based descriptive study.materials and methods : we took all the patients admitted with a diagnosis of diabetic ketoacidosis ( dka ) as defined ada 2006 consensus statement in medical ward from january 2010 to december 2010 . 
 the statistical operations was done through manufactured by ibm corp.results:only sixteen patients ( 7 type 1 and 9 type 2 dm ) were with dka . when compared to the 16 subjects with type 1 dm , the type 2 were older ( 56.8 s 25.7 years ) and had a significantly higher ph levels ( 7.11 s 7.28 p = 0.04 ) . 
 the mean body mass index was 20.52.44 in both type 1 and type 2 dm . 
 four were on diet control and insulin respectively . 
 five were on oral hypoglycemic agents ( oha ) and three on both ( insulin and oha ) . 
 infection was most common precipitating factor ( 56.25% ) followed by poor drug compliance ( 37.5% ) and first presentation ( 6.25%).conclusions : we found majority of patients were type 2 dm . 
 metabolic acidosis has significant association in both type of diabetic . 
 we found infection was the most common precipitating factor for dka .