Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN 55905, USA.
Pediatrics. 2012 Feb;129(2):e511-4. doi: 10.1542/peds.2011-0741. Epub 2012 Jan 16.
Diabetic ketoacidosis (DKA) is a life-threatening condition and a major cause of morbidity and mortality in children with type 1 diabetes mellitus. The deficiency of insulin leads to metabolic decompensation, causing hyperglycemia and ketosis that resolves with the administration of insulin and fluids. However, an induced state of ketosis is the basis for the success of the ketogenic diet (KD), which is an effective therapy for children with intractable epilepsy. We report the case of a 2-year-old girl who presented to the emergency department with 1-week history of decreased activity, polyuria, and decreased oral intake. Her past medical history was remarkable for epilepsy, for which she was started on the KD with a significant improvement. Her laboratory evaluation was compatible with DKA, and fluids and insulin were given until correction. Because of concerns regarding recurrence of her seizures, the KD was resumed along with the simultaneous use of insulin glargine and insulin aspart. Urine ketones were kept in the moderate range to keep the effect of ketosis on seizure control. Under this combined therapy, the patient remained seizure-free with no new episodes of DKA.
糖尿病酮症酸中毒（DKA）是一种危及生命的疾病，也是 1 型糖尿病儿童发病率和死亡率的主要原因。胰岛素缺乏会导致代谢失代偿，导致高血糖和酮症，随着胰岛素和液体的输注可得到缓解。然而，酮症的诱导状态是生酮饮食（KD）成功的基础，KD 是治疗顽固性癫痫儿童的有效方法。我们报告了一例 2 岁女孩的病例，她因活动减少、多尿和摄食减少就诊于急诊 1 周。她的既往病史为癫痫，为此她开始接受 KD 治疗，病情显著改善。她的实验室检查符合 DKA，给予补液和胰岛素直至纠正。由于担心她的癫痫发作再次发生，同时使用甘精胰岛素和门冬胰岛素恢复 KD。尿酮体保持在中等水平以保持酮症对控制癫痫发作的作用。在这种联合治疗下，患者未再发生癫痫，也未再发生 DKA。
