Duck S C, Wyatt D T
Department of Pediatrics, Medical College of Wisconsin, Milwaukee.
J Pediatr. 1988 Jul;113(1 Pt 1):10-4. doi: 10.1016/s0022-3476(88)80521-3.
To determine factors contributing to life-threatening brain herniation in patients treated for severe diabetic ketoacidosis, we analyzed history, laboratory data, rate and composition of fluid and insulin administration, and time to onset of brain herniation in nine new cases and 33 prior reports. The overall rate of fluid administration was inversely correlated with the time of onset of herniation (r = -0.32, p = 0.04). Only 4 of 40 cases occurred at fluid intakes less than or equal to 4.0 L/m2/day. During treatment, "calculated" serum sodium concentrations fell significantly and were less than 130 mEq/L in 33% of cases at the time of herniation. These data indicate that excessive secretion of vasopressin may exacerbate the brain edema, and that limitation of the rate of fluid administration may be prudent.
为了确定在接受严重糖尿病酮症酸中毒治疗的患者中导致危及生命的脑疝形成的因素，我们分析了9例新病例和33篇既往报告中的病史、实验室数据、液体和胰岛素的输注速率及成分，以及脑疝形成的时间。液体输注的总体速率与脑疝形成时间呈负相关（r = -0.32，p = 0.04）。40例病例中只有4例发生在液体摄入量小于或等于4.0 L/m²/天的情况下。在治疗期间，“计算得出的”血清钠浓度显著下降，在脑疝形成时33%的病例中低于130 mEq/L。这些数据表明，血管加压素的过度分泌可能会加重脑水肿，谨慎限制液体输注速率可能是明智的。
