Bai Ke, Fu Yueqiang, Liu Chengjun, Xu Feng, Zhu Min
Intensive Care Unit, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Children Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Labortory of Pediatrics, 136 Zhongshang Er Road, Yuzhong District, Chongqing, 400014, People's Republic of China.
Department of Endocrinology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Children Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Labortory of Pediatrics, Chongqing, 400014, People's Republic of China.
BMC Pediatr. 2017 Dec 19;17(1):209. doi: 10.1186/s12887-017-0960-3.
This study is to explore the clinical characteristics, laboratory diagnosis, and treatment outcomes in pediatric patients with non-diabetic ketoacidosis.
Retrospective patient chart review was performed between March 2009 to March 2015. Cases were included if they met the selection criteria for non-diabetic ketoacidosis, which were: 1) Age ≤ 18 years; 2) urine ketone positive ++ or >8.0 mmol/L; 3) blood ketone >3.1 mmol/L; 4) acidosis (pH < 7.3) and/or HCO < 15 mmol/L; 5) random blood glucose level < 11.1 mmol/L. Patients who met the criteria 1, 4, 5, plus either 2 or 3, were defined as non-diabetic ketoacidosis and were included in the report.
Five patients with 7 episodes of non-diabetic ketoacidosis were identified. They all presented with dehydration, poor appetite, and Kussmaul breathing. Patients treated with insulin plus glucose supplementation had a quicker recovery from acidosis, in comparison to those treated with bicarbonate infusion and continuous renal replacement therapy. Two patients treated with bicarbonate infusion developed transient coma and seizures during the treatment.
Despite normal or low blood glucose levels, patients with non-diabetic ketoacidosis should receive insulin administration with glucose supplementation to correct ketoacidosis.
本研究旨在探讨非糖尿病性酮症酸中毒患儿的临床特征、实验室诊断及治疗结果。
对2009年3月至2015年3月期间的患者病历进行回顾性研究。符合非糖尿病性酮症酸中毒选择标准的病例纳入研究，标准如下：1）年龄≤18岁；2）尿酮阳性++或>8.0 mmol/L；3）血酮>3.1 mmol/L；4）酸中毒（pH<7.3）和/或HCO<15 mmol/L；5）随机血糖水平<11.1 mmol/L。符合标准1、4、5，再加上2或3的患者被定义为非糖尿病性酮症酸中毒并纳入报告。
共识别出5例患者出现7次非糖尿病性酮症酸中毒发作。他们均表现为脱水、食欲减退和库斯莫尔呼吸。与接受碳酸氢盐输注和持续肾脏替代治疗的患者相比，接受胰岛素加葡萄糖补充治疗的患者酸中毒恢复更快。2例接受碳酸氢盐输注治疗的患者在治疗期间出现短暂昏迷和癫痫发作。
尽管血糖水平正常或偏低，但非糖尿病性酮症酸中毒患者仍应接受胰岛素加葡萄糖补充治疗以纠正酮症酸中毒。
