Krakowczyk Helena, Machura Edyta, Rusek-Zychma Malgorzata, Chrobak Ewelina, Ziora Katarzyna
Przegl Lek. 2014;71(6):323-7.
Ketosis in children may result from physiological adaptation to situations like fasting, fat-rich diet, straining physical activity, as well as from serious endocrine or metabolic disorders. The most frequently diagnosed cause of ketoacidosis are states of acetonemia and acetonuria with vomiting, during airways infections.
Assessment of the natural history and clinical presentation of acetonemic vomiting in children.
85 children from 18 months to 12 years of age with acetonemic vomiting were incorporated in this study. Detailed anamnesis, clinical examination, and chosen laboratory parameters were analyzed.
In 18% of the children a familial pattern of the disease was observed, 75% of the parents declared that their children had fat-rich meals on a regular basis, in 47% there was a tendency to recurrent respiratory tract. The most frequently observed symptoms were incoercible vomiting with nausea (100%), abdominal pain (87%), headaches (35%) and febrile states (62%). Ketosis triggers were: infections with insufficient fluid and food intake (68%), and child overfeeding with fat-rich products (23%). Observed biochemical disturbances were ketosis (mean J3-hydroxybutyric acid serum concentration--1.03 mmol/l, SD +/- 0.83), acetonuria, hypoglycemia (15%), metabolic acidosis (17%) and dyselectrolytemia (14%). The treatment of the children consisted in intravenous and oral rehydration, managing acid-base and electrolyte disturbances.
In some children acetonemic vomiting is recurrent, and thus prophylactic management is im- portant in children who are at risk.
儿童酮症可能源于对禁食、高脂饮食、剧烈体育活动等情况的生理适应，也可能由严重的内分泌或代谢紊乱引起。最常被诊断出的酮症酸中毒病因是气道感染期间伴有呕吐的丙酮血症和丙酮尿症状态。
评估儿童丙酮血症性呕吐的自然病史和临床表现。
本研究纳入了85名年龄在18个月至12岁之间患有丙酮血症性呕吐的儿童。分析了详细的病史、临床检查及选定的实验室参数。
18%的儿童观察到疾病的家族模式，75%的家长称其孩子经常食用高脂餐，47%的儿童有反复呼吸道感染倾向。最常观察到的症状是难以控制的恶心呕吐（100%）、腹痛（87%）、头痛（35%）和发热状态（62%）。酮症触发因素为：液体和食物摄入不足的感染（68%）以及儿童食用过多高脂产品（23%）。观察到的生化紊乱包括酮症（平均β-羟基丁酸血清浓度——1.03 mmol/l，标准差±0.83）、丙酮尿症、低血糖（15%）、代谢性酸中毒（17%）和电解质紊乱（14%）。对儿童的治疗包括静脉和口服补液，处理酸碱和电解质紊乱。
在一些儿童中，丙酮血症性呕吐会反复发作，因此对有风险的儿童进行预防性管理很重要。
