de Oliveira Iglesias Simone Brasil, Pons Leite Heitor, de Carvalho Werther Brunow
Pediatric Intensive Care Unit, Department of Pediatrics, Federal University of São Paulo, SãoPaulo, Brazil.
Pediatr Emerg Care. 2009 Dec;25(12):859-61. doi: 10.1097/PEC.0b013e3181c399f6.
We report an unusual case of hypophosphatemia-related seizure in a child with diabetic ketoacidosis (DKA). A 1-year-old type 1 diabetic boy with hyperglycemia, ketoacidosis, and dehydration was admitted to the pediatric intensive care unit. After having received fluid replacement using isotonic solution with added potassium and continuous intravenous insulin administration according to the protocol for DKA, the patient was conscious, awake, and fed with breast milk. After 20 hours of pediatric intensive care unit stay, he presented 2 tonic-clonic seizures followed by apnea. One hour later, he had cardiorespiratory arrest, requiring cardiovascular support and mechanical ventilation. Serum phosphorus concentration was 1.0 mg/dL, and severe hypophosphatemia was diagnosed. Subsequent to intravenous phosphate replacement, he showed improved neurological and hemodynamic statuses. No other cause of cerebral complication was found. He had no neurologic lesions and was discharged. Although hypophosphatemia is a common complication of DKA treatment, phosphate supplementation has not been routinely recommended in the treatment of DKA. Early recognition and treatment of severe hypophosphatemia in the treatment of DKA are important to reduce the risk of neurological complications.
我们报告了一例患有糖尿病酮症酸中毒（DKA）的儿童发生低磷血症相关癫痫发作的罕见病例。一名1岁1型糖尿病男孩因高血糖、酮症酸中毒和脱水入住儿科重症监护病房。根据DKA治疗方案，在接受补充钾的等渗溶液补液并持续静脉输注胰岛素后，患儿意识清醒，可进食母乳。在儿科重症监护病房住院20小时后，他出现了2次强直阵挛性癫痫发作，随后出现呼吸暂停。1小时后，他发生心肺骤停，需要心血管支持和机械通气。血清磷浓度为1.0mg/dL，诊断为严重低磷血症。静脉补充磷酸盐后，他的神经和血流动力学状态有所改善。未发现其他脑部并发症原因。他没有神经病变，随后出院。虽然低磷血症是DKA治疗的常见并发症，但在DKA治疗中尚未常规推荐补充磷酸盐。在DKA治疗中早期识别和治疗严重低磷血症对于降低神经并发症风险很重要。
