Current Concepts and Controversies in Prevention and Treatment of Diabetic Ketoacidosis in Children
Current Concepts and Controversies in Prevention and Treatment of Diabetic Ketoacidosis in Children
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DOI：
10.1007/s11892-012-0307-2
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发表时间：
2012-10-01
影响因子：
4.2
通讯作者：
Rewers, Arleta
中科院分区：
文献类型：
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作者：
Rewers, Arleta
糖尿病酮症酸中毒（DKA）是由绝对或相对缺乏胰岛素引起的。缺乏胰岛素会导致高血糖、酮血症和酸中毒。诊断为1型糖尿病（T1 D）时DKA的患病率在世界各地从18%到84%不等。女性、胰岛素泵使用者、有精神病史或饮食失调史的患者以及次优社会经济环境中DKA复发的发生率较高。DKA是T1 D儿童最常见的死亡原因。患有DKA的儿童应在有经验的中心接受治疗。初始推注10-20 mL/kg 0.9%盐水，然后输注0.45%-0.9%盐水。输液应在胰岛素给药（0.1 U/kg/h）前1-2小时进行。在诊断糖尿病时预防DKA可以通过强化社区干预和教育卫生保健提供者提高认识来实现。预防复发性DKA需要持续的患者教育和获得糖尿病计划和电话服务。
Diabetic ketoacidosis (DKA) is caused by absolute or relative lack of insulin. Lack of insulin leads to hyperglycemia, ketonemia, and acidosis. Prevalence of DKA at diagnosis of type 1 diabetes (T1D) varies around the world from 18 % to 84 %. Incidence of recurrent DKA is higher among females, insulin pump users, those with a history of psychiatric or eating disorder, and suboptimal socioeconomic circumstances. DKA is the most common cause of death in children with T1D. Children with DKA should be treated in experienced centers. Initial bolus of 10-20 mL/kg 0.9 % saline is followed by 0.45 %-0.9 % saline infusion. Fluid infusion should precede insulin administration (0.1 U/kg/h) by 1-2 hours. The prevention of DKA at diagnosis of diabetes can be achieved by an intensive community intervention and education of health care providers to raise awareness. Prevention of recurrent DKA requires continuous patient education and access to diabetes programs and telephone services.