Division of Emergency Medicine, Department of Pediatrics, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Division of Emergency Medicine, Department of Pediatrics, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Am J Emerg Med. 2020 Feb;38(2):329-332. doi: 10.1016/j.ajem.2019.158449. Epub 2019 Oct 24.
The objective of this study was to investigate the significance and prevalence of lactic acidosis in pediatric diabetic ketoacidosis (DKA) presenting to the emergency department.
A retrospective cohort study of children (age ≤ 21 years) presenting to a tertiary care emergency department in DKA from December 1, 2015 to December 1, 2018. Patients needed to have DKA requiring admission to the pediatric intensive care unit and have had a lactate level collected while in the emergency department to be included.
92 patients resulting in 113 encounters had DKA and a lactate level collected in the emergency department. The mean lactate level was 3.5 mmol/L (±SD 2.1). 72 (63.7%) encounters had lactic acidosis (p < 0.001). There was no significant association between the presence of lactic acidosis and pediatric intensive care unit length of stay (p = 0.321), hospital length of stay (p = 0.426), morbidity (p = 0.552) and mortality (p = 1.000). Initial glucose levels were significantly higher in the patients presenting with lactic acidosis (p = 0.001).
Lactic acidosis is a common finding in pediatric DKA patients presenting to the emergency department. Serum lactate alone should not be used as an outcome predictor in pediatric DKA.
本研究旨在探讨乳酸酸中毒在儿科糖尿病酮症酸中毒（DKA）急诊患者中的意义和流行率。
这是一项回顾性队列研究，纳入了 2015 年 12 月 1 日至 2018 年 12 月 1 日期间在三级护理急诊就诊的 DKA 患儿（年龄≤21 岁）。患者需要因 DKA 入住儿科重症监护病房，并且在急诊时采集了乳酸水平方可纳入研究。
92 例患者共 113 次就诊，发生 DKA 并在急诊采集了乳酸水平。乳酸水平的平均值为 3.5mmol/L（±SD 2.1）。72 次（63.7%）就诊存在乳酸酸中毒（p<0.001）。乳酸酸中毒的存在与儿科重症监护病房住院时间（p=0.321）、住院时间（p=0.426）、发病率（p=0.552）和死亡率（p=1.000）均无显著相关性。乳酸酸中毒患者的初始血糖水平显著更高（p=0.001）。
乳酸酸中毒是儿科 DKA 患者在急诊就诊时的常见表现。血清乳酸水平本身不应作为儿科 DKA 的预后预测指标。
