MINIMIZING THE RISK OF BRAIN HERNIATION DURING TREATMENT OF DIABETIC KETOACIDEMIA - A RETROSPECTIVE AND PROSPECTIVE-STUDY
MINIMIZING THE RISK OF BRAIN HERNIATION DURING TREATMENT OF DIABETIC KETOACIDEMIA - A RETROSPECTIVE AND PROSPECTIVE-STUDY
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DOI：
10.1016/s0022-3476(05)82439-4
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发表时间：
1990-07-01
影响因子：
5.1
通讯作者：
FINBERG, L
中科院分区：
文献类型：
--
作者：
HARRIS, GD;FIORDALISI, I;FINBERG, L
我们回顾性研究了119例年龄在13个月至30岁之间的糖尿病酮症酸血症患者的219次发作，以确定在治疗无并发症发作和伴有脑肿胀并发症的发作期间，血清钠浓度随血糖下降的趋势。在20例并发症中，13例为轻度（仅头痛），7例为重度（死亡或濒临死亡）。164例无并发症发作中有82例（54%）血钠未随血糖下降而升高，20例有并发症发作中有18例（95%）血钠未随血糖下降而升高（P < 0.01）。因此，并发症更可能发生在钠浓度未能随葡萄糖下降而升高的患者中。然后前瞻性研究了40例年龄在1岁半至20岁之间的糖尿病酮症酸血症患者的58次发作，采用48小时治疗计划，以提供均匀的赤字量，前12小时内钠赤字为一半。58次发作中有55次（95%）血清钠浓度升高，而葡萄糖浓度下降。无患者发生严重并发症。我们得出结论，血清中测得的钠浓度升高葡萄糖浓度下降的失败是游离水过量给药的标志。延长修复期，在治疗早期使用平均含125 mmol/L Na+的修复液，通常可防止血清钠浓度下降趋势，从而防止有效血清渗透压迅速下降。该方案可能对治疗期间的濒死事件和脑疝具有保护作用。
We studied retrospectively, 219 episodes of diabetic ketoacidemia in 119 patients aged 13 months to 30 years, to determine the trend of the concentration of sodium in serum as glucose declined during treatment of uncomplicated episodes and of episodes with complications attributable to brain swelling. Of 20 complications, 13 were minor (headache only) and 7 major (death or near death). The concentration of sodium in serum failed to rise as that of glucose declined in 82 (54%) of 164 uncomplicated episodes and in 18 (95%) of 20 complicated episodes (p < 0.01). Hence complications were more likely to occur among patients with a failure of the concentration of sodium to rise as glucose declined. Fifty-eight episodes of diabetic ketoacidemia in 40 patients aged 1 1/2 to 20 years were then studied prospectively on a 48-hour treatment plan to provide the volume of deficit evenly, with half the deficit of sodium in the first 12 hours. Sodium concentration in serum rose in 55 (95%) of 58 episodes as that of glucose declined. No patient had a major complication. We conclude that failure of the sodium concentration measured in serum to rise a glucose concentration declines is a marker for excessive administration of free water. An expanded repair period, with repair fluid containing an average of 125 mmol/L Na+ early in therapy, will usually protect against a downward trend in the concentration of sodium in serum and therefore against a rapid decline in effective serum osmolality. This regimen may be protective against near-death episodes and brain herniation during treatment.