Emir Tas, Attending Physician, Division of Endocrinology and Diabetes, Arkansas Children's Hospital, and Assistant Professor, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.
Katrin Wooley, Advanced Nurse Practitioner, Department of Pediatrics, University of Arkansas for Medical Sciences, and Division of Endocrinology and Diabetes, Arkansas Children's Hospital, Little Rock, AR.
J Pediatr Health Care. 2023 Jan-Feb;37(1):56-62. doi: 10.1016/j.pedhc.2022.07.004. Epub 2022 Aug 14.
Diabetic ketoacidosis (DKA) is a common presentation for pediatric new-onset insulin-dependent diabetes mellitus (IDDM). Delayed diagnosis is the major risk factor for DKA at disease onset.
Two pediatric endocrinologists independently reviewed the admission records to assess the appropriateness of preadmission management in various health care settings.
Eighteen percent (n = 45) of patients with new-onset IDDM had a delayed diagnosis. Twenty-eight were misdiagnosed (respiratory [n = 9], nonspecific [n = 7], genitourinary [n = 4], gastrointestinal [n = 8] issues) and 17 were mismanaged. One child died within 4 hr of hospitalization, presumably because of a hyperosmolar coma. Forty-six percent (n = 21) of patients with delayed diagnosis presented with DKA, comprising 18% of all DKA cases.
A significant number of patients with new-onset IDDM were either misdiagnosed or mismanaged. All providers must be appropriately trained in diagnosing new-onset IDDM and follow the standard of clinical care practices.
糖尿病酮症酸中毒（DKA）是儿童新发胰岛素依赖型糖尿病（IDDM）的常见表现。延迟诊断是发病时发生 DKA 的主要危险因素。
两位儿科内分泌学家独立审查入院记录，以评估在各种医疗保健环境下入院前管理的适当性。
18%（n=45）新发 IDDM 患者存在延迟诊断。28 例误诊（呼吸[n=9]、非特异性[n=7]、泌尿生殖[n=4]、胃肠道[n=8]问题），17 例治疗不当。一名儿童在住院后 4 小时内死亡，推测是因为高渗性昏迷。46%（n=21）延迟诊断的患者出现 DKA，占所有 DKA 病例的 18%。
相当数量的新发 IDDM 患者被误诊或治疗不当。所有提供者都必须接受正确的新发 IDDM 诊断培训，并遵循临床护理实践标准。
