糖尿病酮症酸中毒患儿的液体管理
Fluid management in children with diabetic ketoacidosis.
作者信息
McGregor Sophie, Metzger Daniel L, Amed Shazhan, Goldman Ran D
出版信息
Can Fam Physician. 2020 Nov;66(11):817-819.
Abstract
QUESTION
Previous research has indicated that rapid rehydration in children with type 1 diabetes who present with diabetic ketoacidosis could result in cerebral edema. I have been treating patients with diabetic ketoacidosis with gradual fluid replacement. With the risk of cerebral injury in these patients, should I continue management with slow fluid rehydration?
ANSWER
Recent research has shown that neither fluid infusion rate nor sodium chloride concentration increases risk of cerebral injury. However, it is possible for subtle brain injury to occur during treatment, regardless of the fluid administration strategy. The 2018 International Society for Pediatric and Adolescent Diabetes guidelines have been updated in light of this research.
摘要
问题
先前的研究表明，1型糖尿病合并糖尿病酮症酸中毒的儿童快速补液可能会导致脑水肿。我一直在用逐步补液的方法治疗糖尿病酮症酸中毒患者。鉴于这些患者存在脑损伤风险，我是否应该继续采用缓慢补液的治疗方法？
答案
最近的研究表明，输液速度和氯化钠浓度均不会增加脑损伤风险。然而，无论采用何种补液策略，治疗期间都有可能发生轻微脑损伤。2018年国际儿童和青少年糖尿病学会指南已根据这项研究进行了更新。
相似文献
1
Fluid management in children with diabetic ketoacidosis.
Can Fam Physician. 2020 Nov;66(11):817-819.
2
The lethargic diabetic: cerebral edema in pediatric patients in diabetic ketoacidosis.
Air Med J. 2015 Mar-Apr;34(2):109-12. doi: 10.1016/j.amj.2014.10.009.
3
Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis.
N Engl J Med. 2018 Jun 14;378(24):2275-2287. doi: 10.1056/NEJMoa1716816.
4
[Acute cerebral edema complicating therapy for diabetic ketoacidosis in children ].
Arch Fr Pediatr. 1982 Jun-Jul;39(6):375-7.
5
Evidence-based emergency medicine/critically appraised topic. Is fluid therapy associated with cerebral edema in children with diabetic ketoacidosis?
Ann Emerg Med. 2008 Jul;52(1):69-75.e1. doi: 10.1016/j.annemergmed.2008.01.330. Epub 2008 Apr 3.
6
Management of diabetic ketoacidosis in children and adolescents.
Paediatr Drugs. 2008;10(4):209-15. doi: 10.2165/00148581-200810040-00002.
7
Pediatric diabetic ketoacidosis, fluid therapy, and cerebral injury: the design of a factorial randomized controlled trial.
Pediatr Diabetes. 2013 Sep;14(6):435-46. doi: 10.1111/pedi.12027. Epub 2013 Mar 13.
8
European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society consensus statement on diabetic ketoacidosis in children and adolescents.
Pediatrics. 2004 Feb;113(2):e133-40. doi: 10.1542/peds.113.2.e133.
9
Cerebral edema complicating diabetic ketoacidosis in childhood.
J Pediatr. 1980 Mar;96(3 Pt 1):357-61. doi: 10.1016/s0022-3476(80)80672-x.
10
Emergency Medicine Myths: Cerebral Edema in Pediatric Diabetic Ketoacidosis and Intravenous Fluids.
J Emerg Med. 2017 Aug;53(2):212-221. doi: 10.1016/j.jemermed.2017.03.014. Epub 2017 Apr 12.
引用本文的文献
1
Clinical analysis of 20 cases of brain injury caused by diabetic ketoacidosis in children.
BMC Pediatr. 2025 Jul 23;25(1):566. doi: 10.1186/s12887-025-05927-8.
2
Treatment Outcome and Associated Factors among Type 1 Diabetic Children Admitted with DKA in Bahir Dar City Public Referral Hospital, Northwest, Ethiopia: A Cross-sectional Study.
Glob Pediatr Health. 2024 Apr 23;11:2333794X241248320. doi: 10.1177/2333794X241248320. eCollection 2024.
3
Self-care activities in pediatric patients with type 1 diabetes mellitus.
PLoS One. 2024 Mar 5;19(3):e0300055. doi: 10.1371/journal.pone.0300055. eCollection 2024.
本文引用的文献
1
Misdiagnosis and Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes: Patient and Caregiver Perspectives.
Clin Diabetes. 2019 Jul;37(3):276-281. doi: 10.2337/cd18-0088.
2
Increasing prevalence of diabetic ketoacidosis at diabetes diagnosis among children in Quebec: a population-based retrospective cohort study.
CMAJ Open. 2019 May 14;7(2):E300-E305. doi: 10.9778/cmajo.20190047. Print 2019 Apr-Jun.
3
Association Between Cannabis Use and Risk for Diabetic Ketoacidosis in Adults With Type 1 Diabetes.
JAMA Intern Med. 2019 Jan 1;179(1):115-118. doi: 10.1001/jamainternmed.2018.5142.
4
ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state.
Pediatr Diabetes. 2018 Oct;19 Suppl 27:155-177. doi: 10.1111/pedi.12701.
5
Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis.
N Engl J Med. 2018 Jun 14;378(24):2275-2287. doi: 10.1056/NEJMoa1716816.
6
Adherence to a pediatric diabetic ketoacidosis protocol in children presenting to a tertiary care hospital.
Pediatr Diabetes. 2018 Mar;19(2):333-338. doi: 10.1111/pedi.12556. Epub 2017 Jun 30.
7
Self-reported regular alcohol consumption in adolescents and emerging adults with type 1 diabetes: A neglected risk factor for diabetic ketoacidosis? Multicenter analysis of 29 630 patients from the DPV registry.
Pediatr Diabetes. 2017 Dec;18(8):817-823. doi: 10.1111/pedi.12496. Epub 2017 Feb 1.
8
What the Primary Care Provider Needs to Know to Diagnose and Care for Adolescents with Type 1 Diabetes.
J Pediatr. 2016 Dec;179:249-255.e1. doi: 10.1016/j.jpeds.2016.08.077. Epub 2016 Sep 20.
9
Fluid management in pediatric patients with DKA and rates of suspected clinical cerebral edema.
Pediatr Diabetes. 2015 Aug;16(5):338-44. doi: 10.1111/pedi.12268. Epub 2015 Mar 19.
10
Frequency of sub-clinical cerebral edema in children with diabetic ketoacidosis.
Pediatr Diabetes. 2006 Apr;7(2):75-80. doi: 10.1111/j.1399-543X.2006.00156.x.
Zotero 插件