Division of Pediatric Endocrinology and Pediatric Diabetes Center, Massachusetts General Hospital, 175 Cambridge Street, 5th Floor, Boston, MA, 02114, USA.
Paediatr Drugs. 2020 Aug;22(4):357-367. doi: 10.1007/s40272-020-00397-0.
Diabetic ketoacidosis (DKA) is the end result of insulin deficiency in type 1 diabetes mellitus (T1D). Loss of insulin production leads to profound catabolism with increased gluconeogenesis, glycogenolysis, lipolysis, and muscle proteolysis causing hyperglycemia and osmotic diuresis. High levels of counter-regulatory hormones lead to enhanced ketogenesis and the release of 'ketone bodies' into the circulation, which dissociate to release hydrogen ions and cause an overwhelming acidosis. Dehydration, hyperglycemia, and ketoacidosis are the hallmarks of this condition. Treatment is effective repletion of insulin, fluids and electrolytes. Newer approaches to early diagnosis, treatment, and prevention may diminish the risk of DKA and its childhood complications including cerebral edema. However, the potential for some technical and pharmacologic advances in the management of T1D to increase DKA events must be recognized.
糖尿病酮症酸中毒（DKA）是 1 型糖尿病（T1D）中胰岛素缺乏的最终结果。胰岛素产生的丧失导致深刻的分解代谢，增加糖异生、糖原分解、脂肪分解和肌肉蛋白水解，导致高血糖和渗透性利尿。高水平的反调节激素导致酮生成增强，“酮体”释放到循环中，解离释放氢离子，导致酸中毒。脱水、高血糖和酮症酸中毒是这种情况的特征。治疗方法是有效补充胰岛素、液体和电解质。早期诊断、治疗和预防的新方法可能会降低 DKA 及其儿童并发症（包括脑水肿）的风险。然而，必须认识到，T1D 管理方面的一些技术和药理进展有可能增加 DKA 事件的风险。
