Lone Saira Waqar, Siddiqui Emad Uddin, Muhammed Fareeduddin, Atta Irum, Ibrahim Mohsina Noor, Raza Jamal
Department of Paediatric, National Institute of Child Health, Karachi.
J Pak Med Assoc. 2010 Sep;60(9):725-9.
To observe the frequency, demographic data and outcome of diabetic ketoacidosis (DKA) in children with established type 1 diabetes and newly diagnosed diabetes at a tertiary care hospital.
The case record review was done of children admitted with the diagnosis of DKA at The National Institute of Child Health, Karachi from 1st June 2008 till 31st May 2009. All records with the diagnosis of DKA were reviewed and those children with only hyperglycaemia, or who did not fulfill the criteria of DKA were excluded. The demographic data and laboratory investigations which included blood sugar monitoring, arterial blood gases, urine analysis especially for ketones, serum electrolytes, complete blood count and blood culture 'were reviewed. The previous numbers of admissions in children with established DKA were also noted with reasons. The duration of symptoms and fluids required, time of recovery, complications, and outcome were noted and compared between those with established diabetes and children with newly diagnosed diabetes. Data was entered and analyzed on SPSS version 15.
Out of 124 case records, 117 were included which fulfilled the criteria of DKA. A large number, 65 (55.5%) children were in the > 10 years age group with a female predominance. Out of 117 children 50 (42.7%) had established Type 1 diabetes and 67 (57.2 %) children had newly diagnosed diabetes. The commonest presenting complaints in both groups were respiratory distress (87.1%) and vomiting (77.7%). The symptoms of polyuria, polydipsia and nocturia were more among the newly diagnosed children as compared to those with established diabetes with a significant p value <0.001. The comparison of clinical features and laboratory investigations of the two groups showed no difference except that those children with established diabetes improved earlier, required lesser duration of intravenous fluids and their insulin was changed to subcutaneous in less time compared with newly diagnosed children. (p < 0.001). The commonest complication in both groups was hypoglycaemia followed by hyponatraemia, more in newly diagnosed diabetic children.
These soaring numbers are just from one center, highlighting the issue of this much neglected disease in our country. More studies on a larger scale are needed to assess the prevalence/incidence in our children and also more emphasis with educational programmes on prevention of recurrent attacks of DKA.
观察一家三级护理医院中1型糖尿病确诊患儿及新诊断糖尿病患儿糖尿病酮症酸中毒（DKA）的发生率、人口统计学数据及转归情况。
对2008年6月1日至2009年5月31日在卡拉奇国家儿童健康研究所因DKA诊断入院的患儿病历进行回顾。对所有诊断为DKA的记录进行审查，排除仅患有高血糖症或不符合DKA标准的患儿。审查人口统计学数据和实验室检查结果，包括血糖监测、动脉血气分析、尿液分析（尤其是酮体）、血清电解质、全血细胞计数和血培养。记录已确诊DKA患儿既往的入院次数及原因。记录症状持续时间和所需液体量、恢复时间、并发症及转归情况，并在确诊糖尿病患儿和新诊断糖尿病患儿之间进行比较。数据录入SPSS 15版本进行分析。
124份病例记录中，117份符合DKA标准。其中65名（55.5%）儿童年龄大于10岁，女性居多。117名儿童中，50名（42.7%）为1型糖尿病确诊患儿，67名（57.2%）为新诊断糖尿病患儿。两组最常见的主诉均为呼吸窘迫（87.1%）和呕吐（77.7%）。与确诊糖尿病患儿相比，新诊断患儿多尿、多饮和夜尿症状更常见，p值<0.001，差异有统计学意义。两组临床特征和实验室检查结果比较，除确诊糖尿病患儿改善更早、所需静脉输液时间更短、胰岛素转换为皮下注射的时间更短外，其余无差异（p<0.001）。两组最常见的并发症均为低血糖，其次为低钠血症，新诊断糖尿病患儿更常见。
这些激增的数字仅来自一个中心，凸显了我国这种被严重忽视疾病的问题。需要开展更多大规模研究来评估我国儿童的患病率/发病率，同时更加重视开展预防DKA复发的教育项目。
