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  1. Rossman, H., Nik Azlan, N. M., Mahathar , A. W.
    Medicine & Health, 2017;12(2):179-192.
    MyJurnal
    Fluid replacement is the mainstay treatment for diabetic ketoacidosis (DKA). Currently, the best choice of fluids is still debatable. An amount of 0.9% sodium chloride is commonly used. Sterofundin® is an alternative crystalloid that is assumed to expedite resolution of acidosis. Advantages in sterofundin content being smaller significant ion difference (SID) to plasma and lower chloride content. The main objective of the study was to compare rate of acidosis resolution in DKA patients between treatment with 0.9% normal saline and Sterofundin over 12 hrs. Other objectives were to compare significant ion difference (SID), 12-hr blood ketone clearance and electrolyte balance between the two groups. The study was a prospective open labelled randomized control trial. This study was conducted over 6 months. Sample size of 18 was obtained with 9 for each arm. Main difference between two groups was initial median 2-hr pH level improvement (NS = +0.006 vs. Sterofundin = +0.05, P=0.063), however not being significant. Ketone, anion gap reduction, bicarbonate normalisation, sodium, chloride, urea and creatinine levels failed to show any significant differences between both groups. Twelve-hour median chloride levels increments were higher in the NS group (+11) compared to the sterofundin group (+6). There was no difference between mortality and morbidity. Comparing the two fluid groups, there was no significant biochemical differences during treatment of DKA. This was a pilot study that can initiate further clinical trials.
    Keywords: anion gap, diabetic ketoacidosis, ketone, ph, saline, sterofundin
    Matched MeSH terms: Diabetic Ketoacidosis*
  2. Tong CV
    Clin Med (Lond), 2019 Nov;19(6):536.
    PMID: 31732607 DOI: 10.7861/clinmed.Let-19-6-1b
    Matched MeSH terms: Diabetic Ketoacidosis*
  3. Ray S, Sarkar D, Ganguly S, Maiti A
    Med J Malaysia, 2012 Feb;67(1):116-7.
    PMID: 22582562
    Latent Autoimmune Diabetes in Adults (LADA) is an autoimmune form of type 1 diabetes mellitus presenting in adulthood. It is often confused with other types of diabetes and therefore the management is frequently inadequate. Acute hyperglycemic crisis in the form of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS) are unusual findings. We report a clinical case of a 66-year-old female who presented for the first time with DKA and was subsequently diagnosed as a case of LADA. Presumptive diagnosis of LADA was confirmed with the presence of autoantibody to glutamic acid decarboxylase 65 (Anti-GAD65 antibody).
    Matched MeSH terms: Diabetic Ketoacidosis/diagnosis*
  4. Vijayam B, Malarvili MB, Md Shakhih MF, Omar N, Wahab AA
    Clin Nutr ESPEN, 2021 04;42:124-131.
    PMID: 33745565 DOI: 10.1016/j.clnesp.2021.02.005
    BACKGROUND & AIMS: Previous studies have shown that end-tidal carbon dioxide (EtCO2) is lower with the presence of supraphysiological ketones as in the case of chronic ketogenic diet (KD) and diabetic ketoacidosis (DKA). This study aimed to determine changes in EtCO2 upon short term KD.

    METHODS: Healthy subjects were screened not to have conditions that exerts abnormal EtCO2 nor contraindicated for KD. Subjects underwent seven days of KD while the EtCO2 and blood ketone (beta-hydroxybutyrate; β-OHB) parameters were sampled at day zero (t0) and seven (t7) of ketosis respectively. Statistically, the t-test and Pearson's coefficient were conducted to determine the changes and correlation of both parameters.

    RESULTS: 12 subjects completed the study. The mean score ± standard deviation (SD) for EtCO2 were 35.08 ± 3.53 and 35.67 ± 3.31 mm Hg for t0 and t7 respectively. The mean score ±SD for β-OHB were 0.07 ± 0.08 and 0.87 ± 0.84 mmol/L for t0 and t7 respectively. There was no significant difference of EtCO2 between the period of study (p > 0.05) but the β-OHB increased during t7 (p 

    Matched MeSH terms: Diabetic Ketoacidosis*
  5. Tan F, Loh WK
    Diabetes Res Clin Pract, 2010 Nov;90(2):e30-2.
    PMID: 20832134 DOI: 10.1016/j.diabres.2010.08.009
    Two previously healthy Malaysian women presented abruptly with severe diabetic ketoacidosis during pregnancy and immediate postpartum period. Their clinical courses, biochemical and immunological profiles were consistent with fulminant type 1 diabetes first described in the Japanese. Fulminant type 1 diabetes may not be as rare as currently reported outside Japan.
    Matched MeSH terms: Diabetic Ketoacidosis/complications; Diabetic Ketoacidosis/diagnosis
  6. Xue Meng Lim, Christopher Thiam Seong Lim
    MyJurnal
    Diabetic ketoacidosis (DKA) is a medical emergency which requires prompt management to prevent mortality. Treat- ment is complicated in end stage renal failure (ESRF) patients due to their altered physiology in sugar metabolism and fluid haemodynamics. To date, there are only a few case reports illustrating the presentation and management of DKA in ESRF patients and a definite guideline on treatment of DKA in ESRF is seriously lacking. We report here a case of an ESRF patient on maintenance haemodialysis, who develops DKA due to missed insulin, and outline our successful treatment plan. We hope our reported case report research can further contribute to the knowledge of DKA management in ESRF.
    Matched MeSH terms: Diabetic Ketoacidosis
  7. Chou YM, Seak CJ, Goh ZNL, Seak JC, Seak CK, Lin CC
    Medicine (Baltimore), 2018 Jun;97(25):e11056.
    PMID: 29923997 DOI: 10.1097/MD.0000000000011056
    RATIONALE: Diabetic ketoacidosis is a serious and potentially life-threatening acute complication of diabetes mellitus (DM). Euglycemic diabetic ketoacidosis (eDKA) is however challenging to identify in the emergency department (ED) due to absence of marked hyperglycemia, often leading to delayed diagnosis and treatment. eDKA has been recently found to be associated with sodium-glucose cotransporter 2 (SGLT2) inhibitors, one of the newest classes of antidiabetics, though there are very limited reports implicating dapagliflozin as the offending agent in ED patients. Here we report a type 2 diabetic patient who presented to the ED with eDKA secondary to dapagliflozin administration.

    PATIENT CONCERNS: A 61-year-old Asian female with underlying type 2 DM presented to our ED with body weakness, dyspnea, nausea, vomiting, and mild abdominal pain for the past 2 days. These symptoms were preceded by poor oral intake for 1 week due to severe toothache. Dapagliflozin was recently added to her antidiabetic drug regimen of metformin and glibenclamide 2 weeks ago.

    DIAGNOSES: Arterial blood gases showed a picture of severe metabolic acidosis with an elevated anion gap, while ketones were elevated in blood and positive in urine. Blood glucose was mildly elevated at 180 mg/dL. Serum lactate levels were normal. Our patient was thus diagnosed with eDKA.

    INTERVENTION: Our patient was promptly admitted to the intensive care unit and treated for eDKA through intravenous rehydration therapy with insulin infusion.

    OUTCOMES: Serial blood gas analyses showed gradual resolution of the patient's ketoacidosis with normalized anion gap and clearance of serum ketones. She was discharged uneventfully on day 4, with permanent cessation of dapagliflozin administration.

    LESSONS: Life-threatening eDKA as a complication of dapagliflozin is a challenging and easilymissed diagnosis in the ED. Such an ED presentation is very rare, nevertheless emergency physicians are reminded to consider the diagnosis of eDKA in a patient whose drug regimen includes any SGLT2 inhibitor, especially if the patient presents with nausea, vomiting, abdominal pain, dyspnea, lethargy, and is clinically dehydrated. These patients should then be investigated with ketone studies and blood gas analyses regardless of blood glucose levels for prompt diagnosis and treatment.

    Matched MeSH terms: Diabetic Ketoacidosis/chemically induced*; Diabetic Ketoacidosis/complications; Diabetic Ketoacidosis/drug therapy
  8. Shariffuddin II, Rai V, Chan YK, Muniandy RK
    BMJ Case Rep, 2014;2014.
    PMID: 24862427 DOI: 10.1136/bcr-2014-205135
    Care of an acutely ill parturient is particularly difficult when we have to balance the needs of both mother and the fetus to survive. The literature suggests there should be emphasis on stabilising the mother's condition. In dealing with metabolic acidosis, however, we believe delivering the baby early might not only relieve the threat of the acidosis on the mother, it may be the only way to deliver a live baby. We report two parturient women with severe metabolic acidosis which was considerably reduced very soon after the delivery and how our timely delivery resulted in the birth of two neurologically intact babies.
    Matched MeSH terms: Diabetic Ketoacidosis/therapy*
  9. Usman A, Makmor Bakry M, Mustafa N, Rehman IU, Bukhsh A, Lee SWH, et al.
    Diabetes Metab Syndr Obes, 2019;12:1323-1338.
    PMID: 31496770 DOI: 10.2147/DMSO.S208492
    Background: During the progress and resolution of a diabetic ketoacidosis (DKA) episode, potassium levels are significantly affected by the extent of acidosis. However, none of the current guidelines take into account acidosis during resuscitation of potassium level in DKA management, which may increase the risk of cardiovascular adverse events.

    Objective: To assess literature regarding the adjustment of potassium level using pH to calculate pH-adjusted corrected potassium level, and to observe the relationship of cardiovascular outcomes with reported potassium level and pH-adjusted corrected potassium in DKA.

    Methodology: Seven databases were searched from inception to January 2018 for studies which had reported people with diabetes developing diabetic ketoacidosis, in relation to prevalence or incidence, fluid resuscitation or potassium supplementation treatment, treatment or cardiovascular outcomes, and experimentation with DKA management or insulin. Quality of studies was evaluated using Cochrane Risk of Bias and Newcastle Ottawa Scale.

    Results: Forty-seven studies were included in qualitative synthesis out of a total of 10,292 retrieved studies. Forty-one studies discussed the potassium level and blood pH at the time of admission, ten studies discussed cardiovascular outcomes, and only four studies concurrently discussed potassium level, pH, and cardiovascular outcomes. Only two studies were graded as good on the Newcastle Ottawa Scale. The reported potassium level was well within normal range (5.8 mmol/L), whereas pH rendered patients to be moderately acidotic (7.13). Surprisingly, none of the included studies mentioned pH-adjusted corrected potassium level and, hence, this was calculated later. Although mean corrected potassium was within the normal range (3.56 mmol/L), 13 studies had corrected potassium below 3.5 mmol/L and five had it below 3.0 mmol/L. Nevertheless, with the exception of one study, none discussed cardiovascular outcomes in the context of potassium or pH-adjusted potassium level.

    Conclusion: The evidence surrounding cardiovascular outcomes during DKA episodes in light of a pH-adjusted corrected potassium level is scarce. A prospective observational, or preferably, an experimental study in this regard will ensure we can modify and enhance safety of existing DKA treatment protocols.
    Matched MeSH terms: Diabetic Ketoacidosis
  10. Ding, C.H., Tzar M.N., Biswas S., Muttaqillah N.A.S., Wahab A.A.
    MyJurnal
    Catheter-related bloodstream infections caused by Kodamaea ohmeri are generally not considered due to the relative scarcity of reported cases. This is a case of an 85-year-old man with poorly controlled diabetes mellitus who was initially admitted to our hospital for diabetic ketoacidosis. An internal jugular catheter was inserted as part of the initial management. A week later the patient developed a temperature spike and a yeast identified as Kodamaea ohmeri by ID 32 C (bioMérieux, France) was isolated from both his central and peripheral blood cultures. The catheter was removed and the patient was treated with fluconazole despite the organism’s relatively high minimum inhibitory concentration (2 μg/mL) to this antifungal. The fungemia resolved following a 2-weeks course of fluconazole.
    Matched MeSH terms: Diabetic Ketoacidosis
  11. Hong JYH, Jalaludin MY, Mohamad Adam B, Fuziah MZ, Wu LL, Rasat R, et al.
    Malays Fam Physician, 2015;10(3):11-18.
    PMID: 27570603 MyJurnal
    Background: Diabetic ketoacidosis (DKA) is a late presentation of newly diagnosed type 1 diabetes mellitus (DM) in children. The aim of this study was to determine the clinical characteristics of type 1 DM at presentation so that appropriate actions can be taken to promote early diagnosis.
    Methods: This was a retrospective cohort review from a patient registry database. Data on all patients younger than 20 years old diagnosed with type 1 DM who had been registered with the Malaysian Diabetes in Children and Adolescents Registry (DiCARE) from its inception in 2006 until 2009 were analysed.
    Results: The study included 490 children and adolescents, out of which 57.1% were female. The mean (SD) age at diagnosis was 7.5 (3.7) years, which increased from year 2000 to 2009 [6.6 (3.3) years to 9.6 (3.5) years; p = 0.001]. An increasing percentage of DKA at diagnosis was observed from year 2000 (54.5%) to year 2009 (66.7%), which remained high and leveled between 54.5% and 75.0%. DKA was more common in patients with normal weight (p = 0.002) with no significant association with age, gender, ethnicity and status of family history of diabetes mellitus.
    Conclusion: An increasing trend of age at diagnosis of patients with type 1 DM was observed. Besides that, proportion of DKA at diagnosis had remained high over the past decade. This study found that normal weight was associated with status of DKA, thus more detailed investigations are required to determine the risk factors for DKA.
    Matched MeSH terms: Diabetic Ketoacidosis
  12. Fattah SY, Hariri F, Ngui R, Husman SI
    J Mycol Med, 2018 Sep;28(3):519-522.
    PMID: 30205883 DOI: 10.1016/j.mycmed.2018.06.004
    Mucormycosis is a rare fungal infection and high mortality that commonly affects patients with the weakened immune system. We present an unusual case of tongue necrosis probably due to the healthcare-associated mucormycosis (HCM) in a diabetic patient. Although cannot be proved with certainty, we surmise that intubation as a risk factor in our case. The diagnosis was confirmed by histopathological examination (HPE) of the necrotic tissue specimen. The patient was responded well to lipid complex amphotericin B (250mg) regime after surgery. Subsequent follow up revealed that no signs of recurrence. Early, recognition, diagnosis, prompt treatment and awareness among clinician are representing the most effective way of managing the disease.
    Matched MeSH terms: Diabetic Ketoacidosis/complications
  13. Chiavaroli V, Derraik JGB, Jalaludin MY, Albert BB, Ramkumar S, Cutfield WS, et al.
    Pediatr Diabetes, 2019 11;20(7):892-900.
    PMID: 31237756 DOI: 10.1111/pedi.12881
    BACKGROUND: Partial remission (PREM) by the insulin dose-adjusted HbA1c (IDAA1c) method has not been evaluated for the combined associations of ethnicity and socioeconomic status in children and adolescents with type 1 diabetes (T1D).

    OBJECTIVE: To investigate prevalence and predictors of PREM defined by IDAA1c.

    METHODS: Six hundred fourteen of 678 children (aged <15 years) with new-onset T1D (2000-2013) from a regional pediatric diabetes service (Auckland, New Zealand).

    RESULTS: Overall rate of PREM at 3 months was 42.4%, and lower in Māori/Pacific children (28.6%; P = .006) and those of other ethnicities (28.8%; P = .030) compared with New Zealand Europeans (50.4%). Comparing the most and least deprived socioeconomic quintiles, the odds of PREM were lower among the most deprived (adjusted odds ratio [aOR] 0.44; P = .019). Lower rates of PREM were seen in children aged 0 to 4.9 years (23.8%) and 10 to 14 years (40.9%) than in children aged 5 to 9.9 years (57.4%; P

    Matched MeSH terms: Diabetic Ketoacidosis/epidemiology
  14. Chakranon P, Lai YK, Tang YW, Choudhary P, Khunti K, Lee SWH
    Diabet Med, 2020 12;37(12):1966-1976.
    PMID: 31631398 DOI: 10.1111/dme.14156
    AIM: To summarize and evaluate the existing evidence on the effectiveness of distal technology with regard to multiple health outcomes in people with diabetes.

    METHODS: We searched PubMed, EMBASE and the Cochrane Database of Systematic Reviews from database inception to 31 August 2018 for systematic reviews and/or meta-analyses of studies that examined the impact of distal technology and reported any clinical or patient-related outcomes among people with type 1 or type 2 diabetes.

    RESULTS: The umbrella review identified 95 reviews, including 162 meta-analyses with 46 unique outcomes. Evidence from meta-analyses of randomized controlled studies supports the use of distal technology, especially telehealth and mHealth (healthcare delivered by mobile technology), in people with diabetes for improving HbA1c values by 2-4 mmol/mol (0.2-0.4%). For other health outcomes, such as changes in fasting plasma glucose levels, risk of diabetic ketoacidosis or frequency of severe hypoglycaemia, the evidence was weaker. No evidence was reported for most patient-reported outcomes including quality of life, self-efficacy and medication-taking. The evidence base was poor, with most studies rated as low to very low quality.

    CONCLUSION: Distal technologies were associated with a modest improvement in glycaemic control, but it was unclear if they improved major clinical outcomes or were cost-effective in people with diabetes. More robust research to improve wider outcomes in people with diabetes is needed before such technologies can be recommended as part of routine care for any patient group.

    Matched MeSH terms: Diabetic Ketoacidosis/epidemiology
  15. Craig ME, Jones TW, Silink M, Ping YJ
    J Diabetes Complications, 2007 Sep-Oct;21(5):280-7.
    PMID: 17825751 DOI: 10.1016/j.jdiacomp.2006.04.005
    AIMS: The incidence of type 1 diabetes is increasing in many parts of Asia, where resources may not enable targets for glycemic control to be achieved. The aims of this study were to describe glycemic control, diabetes care, and complications in youth with type 1 diabetes from the Western Pacific Region and to identify factors associated with glycemic control and hypoglycemia.
    METHODS: A cross-sectional clinic-based study on 2312 children and adolescents (aged <18 years; 45% males) from 96 pediatric diabetes centers in Australia, China, Hong Kong, Indonesia, Japan, Malaysia, Philippines, Singapore, South Korea, Taiwan, and Thailand was conducted. Clinical and management details were recorded, and finger-pricked blood samples were obtained for central glycated hemoglobin (HbA(1c)).
    RESULTS: The median age of the patients was 12.5 years [interquartile range (IQR)=9.4-15.3 years]; diabetes duration, 4.4 years (IQR=2.5-7.2 years); and HbA(1c) level, 8.3% (IQR 7.4%-9.7%). Insulin treatment consisted of one or two daily injections in 61% of the patients (range=22%-90% by country), and home blood glucose monitoring (range=67%-100%) was practiced by 96%. HbA(1c) level was significantly associated with country, age, diabetes duration, sex, insulin dose per kilogram, insulin regimen, and frequency of home blood glucose measurement in multiple regression analysis. The incidence of severe hypoglycemia, defined as any episode requiring assistance in the previous 3 months, was 73 per 100 patient-years and was associated with country, male sex, higher HbA(1c) level, an insulin regimen with three or more injections, and more frequent home blood glucose testing. The incidence of diabetic ketoacidosis was 10 per 100 patient-years and was associated with country, higher HbA(1c) level, and higher insulin dose per kilogram.
    CONCLUSIONS: There is marked variability in glycemic control, hypoglycemia, complication rates, and diabetes care among children from the Western Pacific Region. Most are not achieving adequate glycemic control, placing them at high risk of microvascular complications.
    Matched MeSH terms: Diabetic Ketoacidosis/epidemiology
  16. Huan, Nai Chien, Wan Awatif Wan Mohd Zohdi
    MyJurnal
    High anion gap metabolic acidosis (HAGMA) is a hallmark of Diabetic Ketoacidosis (DKA). Occasionally, a Normal Anion Gap Metabolic Acidosis (NAGMA) can be seen, especially during the treatment phase. In this case report, a 55-year-old lady with diabetes mellitus who presented with a 2-day history of fever, lethargy and multiple episodes of vomiting and diarrhoea. Initial laboratory investigations revealed: capillary blood glucose as 27 mmol/L, urine ketone as 3+, blood ketone as 3.5 mmol/L, serum bicarbonate as 14 mmol/L, and serum chloride as 95 mmol/L. She was treated with intravenous normal saline fluid resuscitation and constant rate insulin infusion which was fortunately accompanied by stabilization of blood glucose and normalization of blood ketone to 0.2 mmol/L. However, despite normalization of her anion gap (25 to 14), she remained unwell with acidotic breathing due to refractory hyperchloraemic NAGMA with bicarbonate at 11 mol/L and chloride of 112 mmol/L. It was then decided to administer 100 mL of 8.4% Sodium Bicarbonate solution. The next day, she was no longer tachypneic as her bicarbonate and carbon dioxide improved to 21 mmol/L and 32 mmHg respectively. The presence of NAGMA in DKA should prompt clinicians to conduct a thorough search for possible underlying causes, such as gastrointestinal fluid loss, sepsis and chloride load from aggressive fluid resuscitation with normal saline. Sodium bicarbonate should only be considered in intractable cases to correct a NAGMA and not routinely used in the treatment of DKA.
    Matched MeSH terms: Diabetic Ketoacidosis
  17. Usman A, Shaikh MF, Dujaili JA, Mustafa N, Gan SH
    Diabetes Metab Syndr, 2021 Mar 05;15(2):573-580.
    PMID: 33706189 DOI: 10.1016/j.dsx.2021.03.001
    BACKGROUND AND AIMS: Diabetic ketoacidosis (DKA) treatment guidelines recommend to initiate potassium-replacement when serum potassium (SK) drops within normal range, and to withhold insulin if SK is below normal. Despite strict recommendations, hypokalemia is frequently observed in DKA.

    METHODS: Scientific literature was thoroughly searched to find 1) DKA treatment guidelines, 2) studies reporting hypokalemia in DKA, 3) and literature elaborating mechanisms involved in hypokalemia.

    RESULTS: Acidosis affects SK and its regulators including insulin, catecholamines and aldosterone. Current conceptual framework is an argument to gauge the degree of hypokalemia before it strikes DKA patients utilizing SK level after adjusting it with pH. Suggested approach will reduce hypokalemia risk and its associated complications. The nomogram calculates pH-adjusted potassium and expected potassium loss. It also ranks hypokalemia associated risk, and proposes the potassium-replacement rate over given time period. The differences between current DKA treatment guidelines and proposed strategy are also discussed. Moreover, reasons and risk of hyperkalemia due to early initiation of potassium replacement and remedial actions are debated.

    CONCLUSION: In light of proposed strategy, utilizing the nomogram ensures reduced incidence of hypokalemia in DKA resulting in improved clinical and patient outcomes. Pharmacoeconomic benefits can also be expected when avoiding hypokalemia ensures early discharge.

    Matched MeSH terms: Diabetic Ketoacidosis
  18. Arumugasamy N, Siqueira EB
    Med J Malaya, 1970 Dec;25(2):155-60.
    PMID: 4251137
    Matched MeSH terms: Diabetic Ketoacidosis
  19. Mohd Nor NS, Fong CY, Rahmat K, Vanessa Lee WM, Zaini AA, Jalaludin MY
    Eur Endocrinol, 2018 Apr;14(1):59-61.
    PMID: 29922355 DOI: 10.17925/EE.2018.14.1.59
    Cerebral oedema is the most common neurological complication of diabetic ketoacidosis (DKA). However, ischaemic and haemorrhagic brain injury has been reported infrequently. A 10-year old girl who was previously well presented with severe DKA. She was tachycardic with poor peripheral perfusion but normotensive. However, two fast boluses totalling 40 ml/kg normal saline were given. She was transferred to another hospital where she was intubated due to drowsiness. Rehydration fluid (maintenance and 48-hour correction for 7.5% dehydration) was started followed by insulin infusion. She was extubated within 24 hours of admission. Her ketosis resolved soon after and subcutaneous insulin was started. However, about 48 hours after admission, her Glasgow Coma Scale score dropped to 11/15 (E4M5V2) with expressive aphasia and upper motor neuron signs. One dose of mannitol was given. Her symptoms improved gradually and at 26-month follow-up she had a near-complete recovery with only minimal left lower limb weakness. Serial magnetic resonance imaging brain scans showed vascular ischaemic injury at the frontal-parietal watershed regions with haemorrhagic transformation. This case reiterates the importance of monitoring the neurological status of patient's with DKA closely for possible neurological complications including an ischaemic and haemorrhagic stroke.
    Matched MeSH terms: Diabetic Ketoacidosis
  20. Quah BS, Malik AS, Simpson H
    Malays J Med Sci, 2000 Jan;7(1):27-32.
    PMID: 22844212 MyJurnal
    Experience of acute medical, surgical conditions, and clinical procedures of undergraduate students were assessed via a questionnaire survey during the final week of the 1993/1998 programme at the School of Medical Sciences, Univestiti Sains Malaysia. Individual performances were assessed by a scoring system. One hundred and twenty four students responded, (response rate 97%). More than 90% had seen myocardial infarction, cerebrovascular accident, pneumonia, respiratory distress, gastroenteritis, coma, and snake bite. Less than 33% had witnessed acute psychosis, diabetic ketoacidosis, acute hepatic failure, status epilepticus, near drowning, hypertensive encephalopathy, acute haemolysis or child abuse.Acute surgical/obstetrics cases, seen by >90% students, included fracture of long bones, head injury, acute abdominal pain, malpresentation and foetal distress. Less than 33% had observed epistaxis, sudden loss of vision, peritonitis or burns. Among operations only herniorrhaphy, Caesarian section, internal fixation of fracture and cataract extraction were seen by >80% students. The main deficits in clinical procedures are in rectal and vaginal examinations, urine collection and microscopic examinations. The performance of individual students, assessed by a scoring system, showed 15 students had unacceptably low scores (<149/230, 50%), 37 had good scores (>181.4/230, 70%) and 5 had superior scores (197.6/230, 80%).
    Matched MeSH terms: Diabetic Ketoacidosis
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