Velasco Md Jacqueline P, Fogel PhD Joshua, Levine Md PhD Robert L, Ciminera Md Peter, Fagan Md David, Bargman Md Renee
Nassau University Medical Center, Department of Pediatrics, East Meadow, NY, USA Brooklyn College, Department of Business Management, Brooklyn, NY, USA.
Winthrop University Hospital, Department of Pediatric Endocrinology, Mineola, NY, USA.
Pediatr Endocrinol Diabetes Metab. 2017;23(1):6-13. doi: 10.18544/PEDM-23.01.0068.
Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM) that requires appropriate treatment with insulin and intravenous fluids. Both one-bag and two-bag systems of fluid management are used to treat pediatric diabetic ketoacidosis.
We compare the one-bag and two-bag systems of fluid managementwith regard to incidence of hypoglycemia, serum bicarbonate correction, pH correction and discharge from the pediatric intensive care unit (PICU).
This was a retrospective study of 61 patients less than 21 years old admitted to the PICU with a diagnosis of DKA. Of the 61 patients, 38 were treated with the one-bag system and 23 treated with the two-bag system.
The two-bag system had significantly (p=0.03) lower incidence of hypoglycemia (n=2, 8.7%) compared to the one-bag system (n=13, 34.2%). The two-bag system had significantly (p=0.001) fewer hours of PICU stay (M=29.6, SD=15.23) than the one-bag system (M=47.9, SD=22.32). However, there were no significant differences between the bag systems for hours for pH and bicarbonate correction.
The two-bag system is associated with lower incidence of hypoglycemia and faster discharge from the PICU. We recommend that clinicians consider using the two-bag system for fluid management in pediatric patients with diabetic ketoacidosis.
糖尿病酮症酸中毒（DKA）是糖尿病（DM）的一种危及生命的并发症，需要用胰岛素和静脉补液进行适当治疗。单袋和双袋液体管理系统均用于治疗儿童糖尿病酮症酸中毒。
我们比较单袋和双袋液体管理系统在低血糖发生率、血清碳酸氢盐纠正、pH值纠正以及从儿科重症监护病房（PICU）出院方面的情况。
这是一项对61例年龄小于21岁、因DKA诊断入住PICU的患者进行的回顾性研究。61例患者中，38例采用单袋系统治疗，23例采用双袋系统治疗。
与单袋系统（n = 13，34.2%）相比，双袋系统的低血糖发生率显著更低（p = 0.03，n = 2，8.7%）。双袋系统的PICU住院时间显著更少（M = 29.6，SD = 15.23），比单袋系统（M = 47.9，SD = 22.32）。然而，两种系统在pH值和碳酸氢盐纠正时间方面没有显著差异。
双袋系统与低血糖发生率较低以及从PICU更快出院相关。我们建议临床医生考虑在患有糖尿病酮症酸中毒的儿科患者中使用双袋系统进行液体管理。
