Factors predicting cerebral edema in young children with diabetic ketoacidosis and new onset type I diabetes
Factors predicting cerebral edema in young children with diabetic ketoacidosis and new onset type I diabetes
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DOI：
10.1111/j.1651-2227.1997.tb08946.x
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发表时间：
1997-06-01
期刊：
影响因子：
3.8
通讯作者：
Garibaldi, L
中科院分区：
文献类型：
--
作者：
Hale, PM;Rezvani, I;Garibaldi, L
我们试图找出任何可用于预测四名 5 岁以下新发胰岛素依赖型糖尿病和糖尿病酮症酸中毒儿童脑水肿发展的特征。我们回顾性分析并比较了这4名儿童的血清钠浓度（根据血清葡萄糖值进行校正）和有效血清渗透压与10名年龄匹配的新发胰岛素依赖型糖尿病对照者的值，这些对照者在糖尿病酮症酸中毒治疗期间未出现脑水肿。两组初始血清钠值无统计学差异。发生脑水肿的患者初始血糖值较低，有效血清渗透压较低。在治疗期间，在治疗的第一个 4 小时后，每 4 小时的间隔，发生脑水肿的患者的平均血清钠和渗透压始终低于对照组。脑水肿患者开始治疗后，血清钠和渗透压逐渐下降，而对照组则保持稳定。这些数据表明，在糖尿病酮症酸中毒治疗期间出现脑水肿的儿童最初具有相对正常的血清渗透压，随后在出现脑水肿之前出现进行性低钠血症和/或血清钠下降的趋势。
We have attempted to identify any characteristics which could be used to predict the development of cerebral edema in four children under 5 years of age with new onset insulin-dependent diabetes mellitus and diabetic ketoacidosis. We retrospectively analysed and compared the concentration of serum sodium (corrected for serum glucose value) and effective serum osmolality of these 4 children with values of 10 age-matched controls with new onset insulin-dependent diabetic mellitus who did not develop cerebral edema during treatment of diabetic ketoacidosis. The initial serum sodium values of the two groups were not statistically different. Patients who developed cerebral edema had lower initial serum glucose values and effective serum osmolality. During treatment, patients who developed cerebral edema had consistently lower mean serum sodium and osmolality than controls at each 4-h interval after the first 4h of therapy. Serum sodium and osmolality declined progressively after the initiation of therapy in cerebral edema patients, while remaining stable in controls. These data suggest that children who develop cerebral edema during treatment for diabetic ketoacidosis initially mag have a relatively normal serum osmolality and subsequently develop progressive hyponatremia and/or a trend of declining serum sodium before developing cerebral edema.