Department of Pediatric Endocrinology, School of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye.
Department of Pediatric Medicine, Pediatric Endocrinology, Bursa City Hospital, Bursa, Türkiye.
J Trop Pediatr. 2024 Feb 7;70(2). doi: 10.1093/tropej/fmae003.
This study compared the effectiveness of the traditional and revised one-bag protocols for pediatric diabetic ketoacidosis (DKA) management.
This single-center retrospective cohort study included children diagnosed with DKA upon admission between 2012 and 2019. Our institution reevaluated and streamlined the traditional one-bag protocol (revised one-bag protocol). The revised one-bag protocol rehydrated all pediatric DKA patients with dextrose (5 g/100 ml) containing 0.45% NaCl at a rate of 3500 ml/m2 per 24 h after the first 1 h bolus of normal saline, regardless of age or degree of dehydration. This study examined acidosis recovery times and the frequency of healthcare provider interventions to maintain stable blood glucose levels.
The revised one-bag protocol demonstrated a significantly shorter time to acidosis recovery than the traditional protocol (12.67 and 18.20 h, respectively; p < 0.001). The revised protocol group required fewer interventions for blood glucose control, with an average of 0.25 dextrose concentration change orders per patient, compared to 1.42 in the traditional protocol group (p < 0.001). Insulin rate adjustments were fewer in the revised protocol group, averaging 0.52 changes per patient, vs. 2.32 changes in the traditional protocol group (p < 0.001).
The revised one-bag protocol for pediatric DKA is both practical and effective. This modified DKA management achieved acidosis recovery more quickly and reduced blood glucose fluctuations compared with the traditional one-bag protocol. Future studies, including randomized controlled trials, should assess the safety and effectiveness of the revised protocol in a broad range of pediatric patients with DKA.
本研究比较了传统和改良单袋方案治疗儿科糖尿病酮症酸中毒（DKA）的效果。
这是一项单中心回顾性队列研究，纳入了 2012 年至 2019 年期间入院时诊断为 DKA 的儿童。我们医院重新评估并简化了传统的单袋方案（改良单袋方案）。改良单袋方案在生理盐水首剂 1 小时后，以 3500ml/m2/24 小时的速度，给所有儿科 DKA 患者输注含 0.45%氯化钠的 5%葡萄糖（5g/100ml）补液，无论年龄或脱水程度如何。本研究检查了酸中毒恢复时间和医疗保健提供者为维持血糖稳定而进行干预的频率。
与传统方案相比，改良单袋方案酸中毒恢复时间明显缩短（分别为 12.67 和 18.20 小时；p<0.001）。改良方案组需要较少的血糖控制干预，每位患者的平均葡萄糖浓度变化医嘱为 0.25 次，而传统方案组为 1.42 次（p<0.001）。改良方案组胰岛素剂量调整较少，每位患者平均 0.52 次，而传统方案组为 2.32 次（p<0.001）。
改良的儿科 DKA 单袋方案既实用又有效。与传统的单袋方案相比，这种改良的 DKA 管理方案能更快地恢复酸中毒，并减少血糖波动。未来的研究，包括随机对照试验，应该评估改良方案在广泛的儿科 DKA 患者中的安全性和有效性。
