阴离子间隙正常化时间在儿童糖尿病酮症酸中毒管理中的作用

The role of anion gap normalization time in the management of pediatric diabetic ketoacidosis.

作者信息

Lazar Isaac, Wizeman-Orlov Dorit, Hazan Guy, Orbach Asaf, Haim Alon, Cavari Yuval, Feinstein Yael, Neeman Eitan, Hershkovitz Eli, Faingelernt Yaniv

机构信息

Pediatric Intensive Care Unit, Saban Center of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel.

Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.

出版信息

Front Pediatr. 2023 May 30;11:1198581. doi: 10.3389/fped.2023.1198581. eCollection 2023.

DOI:10.3389/fped.2023.1198581

PMID:37334219

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10275565/

Abstract

INTRODUCTION

Our aims were to determine whether anion gap normalization time (AGNT) correlates with risk factors related to the severity of diabetic ketoacidosis (DKA) in children, and to characterize AGNT as a criterion for DKA resolution in children admitted with moderate or severe disease.

METHODS

A ten-year retrospective cohort study of children admitted to the intensive care unit with DKA. We used a survival analysis approach to determine changes in serum glucose, bicarbonate, pH, and anion gap following admission. Using multivariate analysis, we examined associations between patients' demographic and laboratory characteristics with delayed normalization of the anion gap.

RESULTS

A total of 95 patients were analyzed. The median AGNT was 8 h. Delayed AGNT (>8 h) correlated with pH < 7.1 and serum glucose >500 mg/dL. In multivariate analysis, glucose >500 mg/dL was associated with an increased risk for delayed AGNT, by 3.41 fold. Each 25 mg/dL elevation in glucose was associated with a 10% increment in risk for delayed AGNT. Median AGNT preceded median PICU discharge by 15 h (8 vs. 23 h).

DISCUSSION

AGNT represents a return to normal glucose-based physiology and an improvement in dehydration. The correlation observed between delayed AGNT and markers of DKA severity supports the usefulness of AGNT for assessing DKA recovery.

摘要

引言

我们的目的是确定阴离子间隙恢复正常时间（AGNT）是否与儿童糖尿病酮症酸中毒（DKA）严重程度相关的危险因素相关，并将AGNT作为中度或重度疾病患儿DKA缓解的标准进行特征描述。

方法

对入住重症监护病房的DKA患儿进行为期十年的回顾性队列研究。我们采用生存分析方法来确定入院后血清葡萄糖、碳酸氢盐、pH值和阴离子间隙的变化。通过多变量分析，我们研究了患者的人口统计学和实验室特征与阴离子间隙延迟恢复正常之间的关联。

结果

共分析了95例患者。AGNT的中位数为8小时。AGNT延迟（>8小时）与pH值<7.1和血清葡萄糖>500mg/dL相关。在多变量分析中，葡萄糖>500mg/dL与AGNT延迟风险增加相关，增加了3.41倍。葡萄糖每升高25mg/dL，AGNT延迟风险增加10%。AGNT的中位数比儿科重症监护病房出院的中位数提前15小时（8小时对23小时）。