Division of Pediatric Endocrinology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY, 10310, USA.
Weill Cornell Medicine, Division of Pediatric Endocrinology, NY Presbyterian Hospital, 505 East 70 Street, New York, NY, 10021, USA.
Curr Diab Rep. 2019 Aug 23;19(10):85. doi: 10.1007/s11892-019-1205-7.
Children and adolescents with acute hyperglycemia and diabetes mellitus frequently have acute, potentially life-threatening presentations which require high-acuity care in an inpatient and often intensive care setting. This review discusses the evaluation and care of hyperglycemia and diabetes mellitus in hospitalized children in both critical and non-critical care settings, highlighting important differences in their care relative to adults.
Diabetic ketoacidosis remains highly prevalent at diagnosis among children with type 1 diabetes, and hyperglycemic hyperosmolar state is increasingly prevalent among children with type 2 diabetes. Recent clinical trials have investigated the potential benefits of various types of intravenous fluids and their rates of administration as well as the risks and benefits of intensive glucose control in critically ill children. The Endocrine Society has developed guidelines focused on managing hyperglycemic hyperosmolar state, outlining important aspects of care shown to decrease morbidity and mortality. In the non-critical illness setting, intensive therapy on newly diagnosed diabetes is increasingly recommended at the outset. With the increasing incidence of diabetes mellitus in children and adolescents, recent studies addressing acute diabetes emergencies help inform best practices for care of hospitalized children with hyperglycemia and diabetes.
患有急性高血糖和糖尿病的儿童和青少年常出现危及生命的急性表现，需要在住院治疗，且通常在重症监护病房进行高敏治疗。本综述讨论了在重症和非重症监护环境下住院患儿高血糖和糖尿病的评估和治疗，重点介绍了与成人相比，其护理方面的重要差异。
1 型糖尿病患儿诊断时仍普遍存在糖尿病酮症酸中毒，2 型糖尿病患儿高血糖高渗状态的患病率也在逐渐增加。最近的临床试验研究了各种类型的静脉输液及其给药速度的潜在益处，以及在危重症患儿中强化血糖控制的风险和益处。内分泌学会制定了专门针对治疗高血糖高渗状态的指南，概述了降低发病率和死亡率的重要护理方面。在非重症疾病环境下，新诊断的糖尿病患者一开始就建议进行强化治疗。随着儿童和青少年糖尿病发病率的增加，最近关于急性糖尿病急症的研究有助于为高血糖和糖尿病住院患儿的护理提供最佳实践信息。
