Department of Pediatrics, Section of Emergency Medicine, University of Colorado Denver, School of Medicine, Aurora, CO 80045, USA.
Curr Diab Rep. 2012 Oct;12(5):524-32. doi: 10.1007/s11892-012-0307-2.
Diabetic ketoacidosis (DKA) is caused by absolute or relative lack of insulin. Lack of insulin leads to hyperglycemia, ketonemia, and acidosis. Prevalence of DKA at diagnosis of type 1 diabetes (T1D) varies around the world from 18 % to 84 %. Incidence of recurrent DKA is higher among females, insulin pump users, those with a history of psychiatric or eating disorder, and suboptimal socioeconomic circumstances. DKA is the most common cause of death in children with T1D. Children with DKA should be treated in experienced centers. Initial bolus of 10-20 mL/kg 0.9 % saline is followed by 0.45 %-0.9 % saline infusion. Fluid infusion should precede insulin administration (0.1 U/kg/h) by 1-2 hours. The prevention of DKA at diagnosis of diabetes can be achieved by an intensive community intervention and education of health care providers to raise awareness. Prevention of recurrent DKA requires continuous patient education and access to diabetes programs and telephone services.
糖尿病酮症酸中毒（DKA）是由绝对或相对缺乏胰岛素引起的。缺乏胰岛素会导致高血糖、酮血症和酸中毒。1 型糖尿病（T1D）诊断时 DKA 的患病率在全球范围内从 18%到 84%不等。女性、胰岛素泵使用者、有精神或饮食障碍病史以及社会经济条件不佳的患者，DKA 复发的发生率更高。DKA 是 T1D 儿童死亡的最常见原因。患有 DKA 的儿童应在有经验的中心接受治疗。初始推注量为 10-20 mL/kg 0.9%生理盐水，随后输注 0.45%-0.9%生理盐水。在开始胰岛素输注（0.1 U/kg/h）前 1-2 小时应先补液。通过强化社区干预和对卫生保健提供者进行教育以提高认识，可以预防糖尿病诊断时的 DKA。预防 DKA 复发需要对患者进行持续的教育，并让患者能够获得糖尿病治疗计划和电话服务。
