Clinical Hospital Merkur, 10000 Zagreb, Croatia.
Department of Pediatrics, University Hospital of Osijek, 31000 Osijek, Croatia.
Medicina (Kaunas). 2019 Jul 10;55(7):362. doi: 10.3390/medicina55070362.
There is an increasing risk of type 1 diabetes mellitus (T1D) among children in Croatia. Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with T1D, with cerebral edema as the most severe complication. Since early recognition of cerebral edema leads to a better outcome, it is important that patients with moderate or severe DKA are closely monitored and treated in pediatric intensive care units (PICUs). The aim of this study is to investigate clinical and laboratory parameters, as well as complications in children treated in PICUs because of DKA. Patients treated due to DKA in the PICU of the University Hospitals of Split and Osijek from 2013 to 2017 were included in this study. Retrospectively collected data included age, gender, clinical signs and symptoms, and various laboratory parameters. After dividing subjects into two groups: Newly diagnosed with T1D (NT1D) and previously diagnosed with T1D (PT1D), collected data were compared between the two groups. A total of 82 patients were enrolled. Those with NT1D were more often treated in the PICU, with two of them developing cerebral edema. Dehydration was the most frequent clinical sign, found in 95% of patients at admission. Decreased consciousness level was found in 41.5% of patients, with majority of them being somnolent. No difference was found between NT1D and PT1D. Additionally, there was no significant difference regarding laboratory data at admission. More children with NT1D required treatment in the PICU due to DKA with two of them developing cerebral edema. Since cerebral edema is a life-threatening condition, treatment of patients with moderate or severe DKA in PICUs will provide necessary monitoring enabling early recognition, treatment, and better treatment outcome. To minimize the incidence of DKA among patients with NT1D, it is important to continuously carry out public health education programs aimed at early identification of signs and symptoms of T1D.
克罗地亚儿童 1 型糖尿病（T1D）的风险日益增加。糖尿病酮症酸中毒（DKA）是 T1D 患儿发病率和死亡率的主要原因，其中脑水肿是最严重的并发症。由于早期识别脑水肿可导致更好的结果，因此重要的是，中度或重度 DKA 患者应在儿科重症监护病房（PICU）中密切监测和治疗。本研究旨在调查因 DKA 在斯普利特和奥西耶克大学医院 PICU 接受治疗的儿童的临床和实验室参数以及并发症。本研究纳入了 2013 年至 2017 年期间因 DKA 在 PICU 接受治疗的患者。回顾性收集的数据包括年龄、性别、临床症状和各种实验室参数。将受试者分为新诊断为 1 型糖尿病（NT1D）和既往诊断为 1 型糖尿病（PT1D）两组，比较两组之间的差异。共有 82 名患者入选。NT1D 患者更常在 PICU 接受治疗，其中 2 例发生脑水肿。脱水是最常见的临床体征，入院时 95%的患者出现脱水。41.5%的患者意识水平下降，其中大多数为嗜睡。NT1D 和 PT1D 之间无差异。此外，入院时的实验室数据无差异。由于 DKA，更多的 NT1D 患儿需要在 PICU 接受治疗，其中 2 例发生脑水肿。由于脑水肿是一种危及生命的情况，因此在 PICU 中对中度或重度 DKA 患者进行治疗将提供必要的监测，从而能够早期识别、治疗和改善治疗结果。为了最大限度地减少 NT1D 患者 DKA 的发生率，重要的是要持续开展针对 T1D 体征和症状的早期识别的公共卫生教育计划。
