Cerebral Oedema Complicating Diabetic Ketoacidosis

ABSTRACT. Signs of raised intracranial pressure (ICP) developed during treatment of diabetic ketoacidosis in a young child. A CT scan revealed cerebral oedema and direct measurement conlirmed elevated ICP. Aggressive treatment was successful in maintaining cerebral perfusion pressure. The child survived with mild handicap in contrast to the poor outcome of previous reports.     

儿童糖尿病酮症酸中毒的治疗

糖尿病酮症酸中毒是儿童常见危急重症,治疗延误或治疗不当会影响糖尿病患儿的预后。国内儿科内分泌遗传代谢学组发布的糖尿病酮症酸中毒处理方案极大地提高了国内儿科救治水平,美国糖尿病学会2006年发布了小儿糖尿病酮症酸中毒治疗方案,与国内方案比较更为细化,在胰岛素治疗开始时间、纠正酸中毒指征及补钾等方面均有所不同,且更强调脑水肿的发现与治疗,值得借鉴。     

Tacrolimus Induced Diabetic Ketoacidosis in Nephrotic Syndrome

Tacrolimus, a reversible calcineurin inhibitor, is known for its diabetogenic potential. The incidence of diabetes is less frequent among the patients of nephrotic syndrome in comparison to organ transplant recipients. Diabetic ketoacidosis (DKA) is even rarer. DKA as the first presentation of new onset tacrolimus induced transient type 1 diabetes despite a lower dose range and low trough level of the drug is being reported in a 12-y-old girl with steroid resistant nephrotic syndrome.     

Clinical Profile of Diabetic Ketoacidosis in Indian Children

Objective  

To study the clinical profile of the Indian children admitted with DKA.     

T-Wave Inversion in Diabetic Ketoacidosis with Normokalemia in an Adolescent

Myriad electrocardiographic changes, such as ST-segment elevation/depression, altered T-wave morphology, and QT prolongation, have been described with hyperkalemia in the setting of diabetic ketoacidosis (DKA) [2, 3]. We present an adolescent with DKA in whom T-wave inversions was seen despite his having normal serum potassium level.     

Predictors of Altered Sensorium at Admission in Children with Diabetic Ketoacidosis

Objective

To predict factors causing altered sensorium at admission in children with diabetic ketoacidosis (DKA).

Methods

This retrospective study was done on 139 children with DKA who presented to Pediatric Emergency of a tertiary care hospital between January 2008 and November 2012. The case records were reviewed and information regarding personal details, clinical features, biochemical parameters and outcome was recorded. Statistical analyses were performed in small STATA version 12. Variables associated with altered sensorium in bivariate analysis (P?Results Mean age was 8.04?±?4.1 y; Male: Female ratio 0.75:1. The newly diagnosed diabetics were 54.6 % whereas rest were known diabetics. Eighty one percent children in severe DKA, 63 % moderate DKA and 18 % mild DKA had altered sensorium at admission. Univariate analysis revealed significant P values (P?P values for pH (for pH 7.1–7.2, AOR-5.47, 95 % CI-1.24–24.1, P?=?0.025 and for pH <7.1, AOR-14.19, 95 % CI - 4.13–48.7, P?=?0.001) using pH >7.2 as the reference category.

Conclusions

Alteration in sensorium in children at initial admission with DKA is associated to low blood pH. ROC curve suggested good discrimination of pH for prediction of altered sensorium. The exact pathophysiologic mechanism of how low pH alters sensorium in DKA is still unknown and requires further studies.     

胰岛素泵治疗儿童1型糖尿病并酮症或酮症酸中毒26例

目的观察胰岛素泵持续皮下注射胰岛素对儿童1型糖尿病并酮症或酮症酸中毒(DK/DKA)的疗效。方法本院内分泌科2003~2005年收治的1型糖尿病并DK/DKA患儿43例,分为治疗组26例和对照组17例。治疗组予胰岛素泵治疗,对照组予小剂量胰岛素持续静脉滴注。比较二组患儿血糖、尿酮体、血pH值变化,住院时间长短。结果1.治疗组血糖下降相对稳定,纠正酸中毒后无反复。2.治疗过程中治疗组未出现低血糖,对照组2例出现。3.住院时间治疗组[(11.92±4.72)d]较对照组[(17.35±4.83)d]治疗组较对照组明显缩短(P<0.001)。结论胰岛素泵持续皮下注射胰岛素治疗儿童1型糖尿病并DK/DKA是安全有效的。     

Predictors and Outcome of Acute Kidney Injury in Children with Diabetic Ketoacidosis

Objective

To identify predictors and outcome of acute kidney injury (AKI) in children with diabetic ketoacidosis (DKA) admitted to a Pediatric Intensive Care Unit (PICU).

Methods

Retrospective case review of 79 children with DKA admitted between 2011-2014.

Results

28 children developed AKI during the hospital stay; 20 (71.4%) recovered with hydration alone. Serum chloride at 24 hours was independently associated with AKI. Children with AKI had prolonged acidosis, longer PICU stay, and higher mortality.

Conclusions

Majority of children with AKI and DKA recover with hydration. Hyperchloremia at 24 hours had independent association with AKI, although cause-effect relation could not be ascertained.

     

Reduced Glomerular Filtration and Elevated Urinary Protein Excretion in Diabetic Ketoacidosis

ABSTRACT. Glomerular filtration rate (GFR) was measured by two methods in 9 children with diabetic ketoacidosis (DKA), directly by true creatinine clearance and indirectly by means of serum beta-2-microglobulin levels. We found significantly reduced GFR in the first hours of DKA. The rapid improvement in GFR after fluid and electrolyte replacement indicates that volume depletion is the major cause of low filtration rate. In spite of the reduced GFR we observed pronounced albuminuria and low molecular weight (LMW) proteinuria. We conclude that the pathological albuminuria and microalbuminuria in DKA are caused not by glomerular hyperfiltration but by tubular dysfunction     

儿童糖尿病酮症酸中毒诊治新进展

糖尿病酮症酸中毒(DKA)是儿科临床上最常见的内分泌急症之一,如延误诊断或处理不当可能危及患儿生命.现参照国际儿童及青少年糖尿病协会颁布的2006统一指南,对儿童DKA的诊断及治疗进展作一综述.