儿童糖尿病酮症酸中毒43例临床特点分析
Clinical characteristics of diabetic ketoacidosis in 43 children
投稿时间:2019-02-28  
DOI:10.11724/jdmu.2019.04.10
中文关键词:  糖尿病酮症酸中毒  儿童  胰岛素  糖尿病
英文关键词:diabetic ketoacidosis (DKA)  children  insulin  diabetes mellitus
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作者单位
李琳珊 大连市儿童医院 内分泌科辽宁 大连 116012 
苏 芊 大连市儿童医院 内分泌科辽宁 大连 116012 
常 波 大连市儿童医院 内分泌科辽宁 大连 116012 
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中文摘要:
      目的 分析儿童糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)的临床特点,总结临床治疗经验。方法 回顾性分析2015年1月至2018年8月大连市儿童医院住院的43例首发糖尿病酮症酸中毒患儿的临床资料。年龄<2岁2例(4.7%),2岁≤年龄<5岁7例(16%),5岁≤年龄<10岁19例(44%),≥10岁15例(35%),有15例(35%)有糖尿病家族史,其中2例为2型糖尿病。所有入院患儿均进行血、尿常规、血糖、血气分析、血钠、血钾、肾功能(尿素氮、肌酐)、血浆有效渗透压等检测,按2009年儿童糖尿病酮症酸中毒诊疗指南进行治疗。结果 39例(91%)有明显的皮肤干燥、皮肤弹性减退等脱水表现;有典型的多饮、多尿、多食伴消瘦病例34例(79%);深大、叹气样呼吸就诊患儿26例(60%),以呕吐、腹痛等消化道症状起病者19例(44%);以胸闷、气促症状起病者25例(58%);以双下肢无力起病者1例;8例(19%)合并意识状态改变;10例(23%)表现发热;3例合并高血糖高渗状态,1例发生脑水肿。43例尿酮体均为强阳性,血气分析均提示代谢性酸中毒。43例全部给予液体复苏,普通胰岛素持续静脉滴注,经过积极治疗,42例DKA患儿均康复出院,1例因并发脑水肿死亡。结论 儿童DKA临床表现复杂多样,无特异性,易漏诊误诊,提高认症、早期诊断、合理治疗是降低DKA致死率的重要途径。
英文摘要:
      Objective To analyze the clinical characteristics of diabetic ketoacidosis (DKA) in children and summarize the experience of clinical treatment.  Methods The clinical data of 43 children with first-episode diabetic ketoacidosis, who were hospitalized in Dalian Children's Hospital from January 2015 to August 2018, were retrospectively analyzed: age<2 years old:2 cases(4.7%),≥2-5 years old: 7 cases (16%),≥5-10 years old: 19 cases (44%),≥10 years old: 15 cases (35%). Fifteen patients (35%) had a family history of diabetes, including type 2 diabetes mellitus within 2 patients. The patients’ clinical manifestations, signs, laboratory examinations, and treatment effects were observed. All hospitalized children were tested for blood, urine routine, blood sugar, blood gas analysis, blood sodium, blood potassium, renal function (urea nitrogen, creatinine), plasma effective osmotic pressure etc. Treatment was carried out according to the guidelines for diagnosis and treatment of diabetic ketoacidosis in children in 2009.  Results The clinical symptoms include dehydration such as dry skin and decreased skin elasticity in 39 cases (91%); typical polydipsia, polyuria, polyphagia and emaciation in 34 cases (79%);deep and sigh-like breathing in 26 (60%);gastrointestinal symptoms such as vomiting and abdominal pain in 19 cases (44%); chest tightness and shortness of breath in 25 cases (58%); weakness of both lower limbs in 1 case. The patients were complicated with change of consciousness in 8 cases (19%); fever in 10 cases (23%); hyperglycemic hyperosmolar state in 3 cases;and cerebral edema in 1 case. Urinary sugar and ketone body were strongly positive in all 43 cases. Blood gas analysis revealed metabolic acidosis. All patients were given fluid resuscitation and continuous intravenous drip of ordinary insulin. Among them, 42 children with DKA were discharged from hospital, and 1 patient died due to poor prognosis of cerebral edema.  Conclusion Clinical manifestations of DKA in children are complex, diverse and non-specific, easy to miss diagnosis and misdiagnose. Improved knowledge, early diagnosis and reasonable treatment are important to reduce the mortality rate of DKA.
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