Azzopardi Joseph, Gatt Alex, Zammit Anthony, Alberti George
The Diabetic Clinic, St. Luke's Hospital, Gwardamangia, Malta.
Diabetes Res Clin Pract. 2002 Aug;57(2):87-92. doi: 10.1016/s0168-8227(02)00019-0.
Each of ten adult patients consecutively admitted in DKA (diabetic ketoacidosis) was infused with either 0.15 or 0.12 mol/l saline as part of the treatment regimen. Computerized tomography (CT) scans of the brain were performed before treatment, and at 6-12 and 24 h together with a number of blood variables. The CT scans of a group of ten patients with no history of diabetes were studied as controls. The CT scans of all diabetic patients in DKA showed a definite increase in brain tissue density when compared with those of non-diabetic subjects (mean 36.2 vs. 28.9 Hounsfield units (HU), P<0.001). This did not change with either fluid regimen over the first 24 h. There was a statistically significant difference in brain tissue density between the CT scans of patients in DKA compared with CT scans taken >6 months after the last episode of DKA (32.6 vs. 25.4 HU, P<0.001). The CT scans taken >6 months after the last episode of DKA showed normal brain tissue density with no statistically significant differences from those of control scans. The density of diabetic brains on CT scanning during ketoacidosis is increased; this may be due to cerebral dehydration. This paper does not provide any evidence of cerebral oedema in adults during the treatment of ketoacidosis with isotonic and hypotonic fluids.
作为治疗方案的一部分，连续收治的10例成年糖尿病酮症酸中毒（DKA）患者分别输注了0.15或0.12 mol/l的生理盐水。在治疗前、6 - 12小时和24小时进行脑部计算机断层扫描（CT），并检测多项血液指标。选取10例无糖尿病病史的患者的CT扫描结果作为对照。与非糖尿病患者相比，所有DKA糖尿病患者的CT扫描显示脑组织密度明显增加（平均36.2对28.9亨氏单位（HU），P<0.001）。在最初24小时内，两种补液方案下这一情况均未改变。与上次DKA发作6个月后进行的CT扫描相比，DKA患者的CT扫描脑组织密度存在统计学显著差异（32.6对25.4 HU，P<0.001）。上次DKA发作6个月后进行的CT扫描显示脑组织密度正常，与对照扫描结果无统计学显著差异。酮症酸中毒期间糖尿病患者脑部CT扫描密度增加；这可能是由于脑脱水所致。本文未提供使用等渗和低渗液体治疗酮症酸中毒期间成人大脑出现脑水肿的任何证据。
