Edge Julie A, Roy Yvonne, Bergomi Andrea, Murphy Nuala P, Ford-Adams Martha E, Ong Ken K, Dunger David B
Department of Paediatrics, John Radcliffe Hospital, Oxford, UK.
Pediatr Diabetes. 2006 Feb;7(1):11-5. doi: 10.1111/j.1399-543X.2006.00143.x.
To ascertain whether initial depression of conscious level in children with diabetic ketoacidosis (DKA) is related to hyperosmolality, acidosis or other factors.
In 225 episodes of DKA without evidence of cerebral edema, we examined the relationship between conscious level and initial biochemical variables. We contrasted these findings with those in 42 children who later developed cerebral oedema.
On admission, 42/225 (19%) had mild (pH 7.26-7.35); 96 (44%) moderate (pH 7.11-7.25); and 80 (37%) severe DKA (pH <or= 7.10). Conscious level: alert and oriented (group 1, n=123), drowsy but oriented when woken (group 2, n=62), semi-conscious or confused/agitated (group 3, n=9), comatose (group 4, n=4). Glasgow Coma Score (GCS) was available in 65. pH varied significantly with conscious level; group 1, 7.20+/- 0.11(mean+/- SD); group 2, 7.10+/- 0.16; group 3, 6.96+/- 0.11; group 4, 6.88+/- 0.09 (anova, p<0.001). Blood glucose (BG) was not different between the groups. GCS was related to pH (r(s) = 0.49, p < 0.001), but not to BG or electrolyte levels. Age, sex, plasma sodium, corrected sodium and osmolality also varied with conscious level in a univariate model. Using multivariate analysis comparing groups 1 with groups 2-4, lower pH and younger age were the only independent determinants of impaired conscious level (p<0.001, p=0.036). Conscious level in the children with cerebral edema was also closely related to pH and not to other biochemical variables. pH was lower at each conscious level in the children with later cerebral edema.
In children with DKA, initial conscious level is closely related to pH and weakly to age, but not to BG or plasma sodium level. Thus cerebral function in DKA is related to severity of acidosis even when there is no evidence of cerebral edema.
确定糖尿病酮症酸中毒（DKA）患儿意识水平的初始降低是否与高渗状态、酸中毒或其他因素有关。
在225例无脑水肿证据的DKA发作中，我们研究了意识水平与初始生化变量之间的关系。我们将这些结果与42例后来发生脑水肿的患儿的结果进行了对比。
入院时，42/225例（19%）为轻度（pH 7.26 - 7.35）；96例（44%）为中度（pH 7.11 - 7.25）；80例（37%）为重度DKA（pH≤7.10）。意识水平：清醒且定向力正常（第1组，n = 123），嗜睡但唤醒时有定向力（第2组，n = 62），半昏迷或意识模糊/烦躁不安（第3组，n = 9），昏迷（第4组，n = 4）。65例有格拉斯哥昏迷评分（GCS）。pH随意识水平有显著变化；第1组，7.20±0.11（均值±标准差）；第2组，7.10±0.16；第3组，6.96±0.11；第4组，6.88±0.09（方差分析，p<0.001）。各组间血糖（BG）无差异。GCS与pH相关（r(s)=0.49，p<0.001），但与BG或电解质水平无关。在单变量模型中，年龄、性别、血钠、校正钠和渗透压也随意识水平而变化。使用多变量分析比较第1组与第2 - 4组，较低的pH和较年轻的年龄是意识水平受损的唯一独立决定因素（p<0.001，p = 0.036）。脑水肿患儿的意识水平也与pH密切相关，而与其他生化变量无关。后来发生脑水肿的患儿在每个意识水平时pH都较低。
在DKA患儿中，初始意识水平与pH密切相关，与年龄弱相关，但与BG或血钠水平无关。因此，即使没有脑水肿证据，DKA中的脑功能也与酸中毒的严重程度有关。
