The risk and outcome of cerebral oedema developing during diabetic ketoacidosis
The risk and outcome of cerebral oedema developing during diabetic ketoacidosis
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DOI：
10.1136/adc.85.1.16
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发表时间：
2001-07-01
影响因子：
5.2
通讯作者：
Dunger, DB
中科院分区：
文献类型：
--
作者：
Edge, JA;Hawkins, MM;Dunger, DB
背景-脑水肿是胰岛素依赖型糖尿病儿童发病率和死亡率的主要原因。目的-确定脑水肿并发糖尿病酮症酸中毒（DKA）的风险和结果。方法-1995年10月至1998年9月期间，英国儿科监测单位报告了英格兰、苏格兰和威尔士所有脑水肿病例。在1996年3月至1998年2月期间，通过单独的报告系统，225名儿科医生报告了DKA的AH发作，这些儿科医生被确定为参与糖尿病儿童的护理。要求提供关于脑水肿病例的临床表现、治疗和结局的更多信息。脑水肿的风险进行了调查，年龄，性别，季节性，以及是否糖尿病是新的或以前diagnosed.Results-A共34例脑水肿和2940发作的DKA确定。发生脑水肿的计算风险为6.8/1000次DKA发作。新发糖尿病（11.9/1000次发作）高于确诊糖尿病（3.8/1000）。没有性别或年龄差异。脑水肿与一个显着的死亡率（24%）和发病率（35%的幸存者）。结论，这第一个大的人口为基础的研究脑水肿并发DKA产生的风险估计，这是更可靠的，不太容易受到偏见比以前的研究。我们的研究表明，脑水肿仍然是儿童期DKA的重要并发症，并与显著的发病率和死亡率相关。在这种情况下，脑水肿的病因知之甚少，我们目前正在进行一项病例对照研究，以解决这个问题。
Background-Cerebral oedema is a major cause of morbidity and mortality in children with insulin dependent diabetes.Aims-To determine the risk and outcome of cerebral oedema complicating diabetic ketoacidosis (DKA).Methods-All cases of cerebral oedema in England, Scotland, and Wales were reported through the British Paediatric Surveillance Unit between October 1995 and September 1998. Ah episodes of DKA were reported by 225 paediatricians identified as involved in the care of children with diabetes through a separate reporting system between March 1996 and February 1998. Further information about presentation, management, and outcome was requested about the cases of cerebral oedema. The risk of cerebral oedema was investigated in relation to age, sex, seasonality, and whether diabetes was newly or previously diagnosed.Results-A total of 34 cases of cerebral oedema and 2940 episodes of DKA were identified. The calculated risk of developing cerebral oedema was 6.8 per 1000 episodes of DKA. This was higher in new (11.9 per 1000 episodes) as opposed to established (3.8 per 1000) diabetes. There was no sex or age difference. Cerebral oedema was associated with a significant mortality (24%) and morbidity (35% of survivors).Conclusions-This first large population based study of cerebral oedema complicating DKA has produced risk estimates which are more reliable and less susceptible to bias than those from previous studies. Our study indicates that cerebral oedema remains an important complication of DKA during childhood and is associated with significant morbidity and mortality. Little is known of the aetiology of cerebral oedema in this condition and we are currently undertaking a case control study to address this issue.