The management of diabetic ketoacidosis in children.
The management of diabetic ketoacidosis in children.
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DOI：
10.1007/s13300-010-0008-2
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发表时间：
2010-12
期刊：
影响因子：
3.8
通讯作者：
Rosenbloom, Arlan L
中科院分区：
文献类型：
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作者：
Rosenbloom, Arlan L
本综述的目的是提供儿童和青少年糖尿病酮症酸中毒（DKA）的定义、频率、危险因素、病理生理学、诊断考虑和管理建议，并传达DKA并发症或其管理（特别是最常见的并发症脑水肿（CE））导致永久性残疾或死亡的原因的现有知识。诊断为儿童糖尿病时DKA的发生率为10%-70%，随医疗保健的可用性和社区1型糖尿病（T1 D）的发病率而变化。DKA复发率也取决于医疗服务和社会经济状况。管理应在有经验的中心进行，在这些中心可以足够频繁地监测生命体征、神经系统状态和生化，以预防并发症，或者在CE的情况下，快速干预甘露醇或高渗盐水输注。输液应在胰岛素给药（0.1 U/kg/h）前1-2小时进行;初始推注10-20 mL/kg 0.9%生理盐水，随后推注0.45%生理盐水，以提供维持并替代5%-10%脱水。钾（K）必须尽早和充分地补充。禁忌使用Bicycline。预防糖尿病发作时的DKA需要知情的社区和高度的怀疑指数;预防复发性DKA（几乎总是由于胰岛素遗漏）需要团队的努力。
The object of this review is to provide the definitions, frequency, risk factors, pathophysiology, diagnostic considerations, and management recommendations for diabetic ketoacidosis (DKA) in children and adolescents, and to convey current knowledge of the causes of permanent disability or mortality from complications of DKA or its management, particularly the most common complication, cerebral edema (CE). DKA frequency at the time of diagnosis of pediatric diabetes is 10%–70%, varying with the availability of healthcare and the incidence of type 1 diabetes (T1D) in the community. Recurrent DKA rates are also dependent on medical services and socioeconomic circumstances. Management should be in centers with experience and where vital signs, neurologic status, and biochemistry can be monitored with sufficient frequency to prevent complications or, in the case of CE, to intervene rapidly with mannitol or hypertonic saline infusion. Fluid infusion should precede insulin administration (0.1 U/kg/h) by 1–2 hours; an initial bolus of 10–20 mL/kg 0.9% saline is followed by 0.45% saline calculated to supply maintenance and replace 5%–10% dehydration. Potassium (K) must be replaced early and sufficiently. Bicarbonate administration is contraindicated. The prevention of DKA at onset of diabetes requires an informed community and high index of suspicion; prevention of recurrent DKA, which is almost always due to insulin omission, necessitates a committed team effort.