背景:糖尿病酮症酸中毒(DKA)是1型糖尿病(T1DM)的一种危及生命的并发症,也是儿童发病和死亡的主要原因。我们的目标是评估频率,临床特征,生化结果,儿童和青少年T1DM发病时DKA的结局。
方法:这项回顾性队列研究分析了在阿卜杜勒阿齐兹国王大学医院急诊科就诊的≤16岁患者的病历,吉达,沙特阿拉伯,2015年4月至2019年6月。DKA的严重程度根据国际儿科和青少年糖尿病协会(ISPAD)标准进行分类。
结果:在207例T1DM患者中,53以DKA为新发。平均年龄8.51±3.81岁,大多数为5-10岁(52.8%)。多尿(98.1%),多饮(86.8%),体重减轻(62.3%),腹痛和呕吐(45.3%)是最常见的症状。平均随机血糖为424.09±108.67mg/dL,平均静脉pH为7.15±0.36mmol/L。在患者中,66%无相关并发症,24.4%有低钾血症,20.8%出现低血糖,18.9%的人发生了高氯血症代谢性酸中毒。1例患者出现脑水肿和昏迷。基于代谢性酸中毒,24.5%有轻度DKA,同样比例的人有严重的DKA,9.4%有中度DKA。在患者中,88.7%被送往儿科病房,15.1%被送往重症监护病房。
结论:17岁以下诊断为T1DM的患者中,有25%出现DKA。没有永久性残疾或死亡报告。需要建立专门针对T1DM的注册表来对这些患者进行随访,尤其是学龄儿童,以及帮助当地未来研究的发展。
BACKGROUND: Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM) and a leading cause of morbidity and mortality in children. We aim to assess the frequency, clinical characteristics, biochemical findings, and outcomes of DKA at the onset of T1DM in young children and adolescents.
METHODS: This retrospective cohort
study analyzed the medical records of patients ≤ 16 years old seen in the emergency department at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between April 2015 and June 2019. The severity of DKA was classified according to the International Society for Pediatric and Adolescent Diabetes (ISPAD) criteria.
RESULTS: Out of 207 patients with T1DM, 53 presented with DKA as a new onset. The mean age was 8.51 ± 3.81 years, with the majority being 5-10 years old (52.8%). Polyuria (98.1%), polydipsia (86.8%), weight loss (62.3%), and abdominal pain and vomiting (45.3%) were the most frequent symptoms. Mean random blood glucose was 424.09 ± 108.67 mg/dL and mean venous pH was 7.15 ± 0.36 mmol/L. Of patients, 66% had no associated complications, 24.4% had hypokalemia, 20.8% developed hypoglycemia, and 18.9% developed hyperchloremic metabolic acidosis. One patient had cerebral edema and coma. Based on metabolic acidosis, 24.5% had mild DKA, an equal percentage had severe DKA, and 9.4% had moderate DKA. Of patients, 88.7% were admitted to the pediatric ward and 15.1% to the intensive care unit.
CONCLUSIONS: A total of 25% of patients diagnosed with T1DM below the age of 17 years presented with DKA. No permanent disabilities or deaths were reported. Forming a registry dedicated to T1DM is needed to follow up on these patients, especially among school-age children, as well as aid in the development of future research locally.