Talebi Hanieh, Razavi Zahra, Khazaei Salman
Department of Pediatrics, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, IRN.
Department of Epidemiology, Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, IRN.
Cureus. 2024 Jul 10;16(7):e64241. doi: 10.7759/cureus.64241. eCollection 2024 Jul.
Background and objectives The traditional treatment approach to diabetic ketoacidosis (DKA) involves the replacement of fluid and electrolyte deficits and a continuous intravenous infusion of regular insulin. Several clinical trials supported the administration of subcutaneous rapid-acting insulin analogs in the management of uncomplicated DKA. This study aimed to determine the effects/safety of subcutaneous rapid-acting insulin aspart injections in treating uncomplicated mild and moderate DKA in children. Methods In this prospective study in 2022, 25 children with mild/or moderate DKA were enrolled. The main outcome measure was median time (hours) for the resolution of ketoacidosis. Data recorded were as follows: clinical characteristics, severity of ketoacidosis and dehydration, blood glucose, sodium, potassium, creatinine, urine ketones, hospitalization's duration, and complications. Based on the degree of dehydration, fluid deficit was replaced by sodium chloride 0.45%. Insulin aspart 0.15 units/kg subcutaneous injections were given every 2 hours in the hospital outside ICU. Blood glucose was measured hourly and blood gases every 2 hours. Ketoacidosis was considered resolved when the patient did not have nausea/vomiting, was conscious, and could eat, and blood glucose was <250 mg/dL, pH was >7.30, and/or HCO was >15 mmol/L. Results Of 25 DKA patients (mean age 11.06±3.89, range 4-17 years, 60% girls), 16 cases (64%) had established type 1 diabetes. Overall, 13 (52%) cases had mild ketoacidosis (average pH=7.25), and 12 (48%) cases had moderate ketoacidosis (average pH=7.15). The mean time to resolution of ketoacidosis was 11.24 hours. All but one patient met DKA recovery criteria without complications. Mild cases compared to moderate cases of DKA had a shorter duration to resolution of DKA (p = 0.04). Mean duration of hospitalization was 2.3 days. No electrolyte disturbances, hypoglycemia events, readmission or mortality, or other adverse effects were observed. Conclusion In children with mild and moderate DKA, subcutaneous rapid-acting insulin aspart administration was an effective, safe, and convenient treatment.
糖尿病酮症酸中毒（DKA）的传统治疗方法包括补充液体和电解质缺乏以及持续静脉输注正规胰岛素。多项临床试验支持皮下注射速效胰岛素类似物用于治疗非复杂性DKA。本研究旨在确定皮下注射速效胰岛素门冬在治疗儿童非复杂性轻度和中度DKA中的效果/安全性。方法：在这项2022年的前瞻性研究中，纳入了25例轻度/或中度DKA儿童。主要结局指标是酮症酸中毒缓解的中位时间（小时）。记录的数据如下：临床特征、酮症酸中毒和脱水的严重程度、血糖、钠、钾、肌酐、尿酮体、住院时间和并发症。根据脱水程度，用0.45%氯化钠补充液体缺乏。在医院重症监护室外，每2小时皮下注射0.15单位/千克门冬胰岛素。每小时测量血糖，每2小时测量血气。当患者无恶心/呕吐、意识清醒、能进食且血糖<250mg/dL、pH>7.30和/或HCO>15mmol/L时，认为酮症酸中毒已缓解。结果：25例DKA患者（平均年龄11.06±3.89岁，范围4 - 17岁，60%为女孩），16例（64%）患有1型糖尿病。总体而言，13例（52%）为轻度酮症酸中毒（平均pH = 7.25），12例（48%）为中度酮症酸中毒（平均pH = 7.15）。酮症酸中毒缓解的平均时间为11.24小时。除1例患者外，所有患者均符合DKA恢复标准且无并发症。与中度DKA病例相比，轻度病例的DKA缓解时间更短（p = 0.04）。平均住院时间为2.3天。未观察到电解质紊乱、低血糖事件、再次入院或死亡或其他不良反应。结论：对于轻度和中度DKA儿童，皮下注射速效胰岛素门冬是一种有效、安全且方便的治疗方法。
