Özel Abdulrahman, Erol Esra Ecem, Yüce Servet, Büke Övgü, Tahmiscioglu Feride, Erol Meltem
Bagcılar Training and Research Hospital, Department of Pediatrics, Pediatric Intensive Care Unit, Health Sciences University Turkey, Istanbul, Turkey.
Bagcılar Training and Research Hospital, Department of Pediatrics, Health Sciences University Turkey, Istanbul, Turkey.
Wien Klin Wochenschr. 2025 Feb;137(3-4):98-104. doi: 10.1007/s00508-024-02428-z. Epub 2024 Sep 11.
Serum lactate levels have been recognized as a robust marker for predicting disease severity and survival in many critically ill children but consensus is lacking regarding its utility in diabetic ketoacidosis. This study aimed to investigate the relationship between initial lactate levels and disease severity in pediatric patients presenting with diabetic ketoacidosis.
This single-center retrospective descriptive study involved pediatric patients with diabetic ketoacidosis in the pediatric emergency department between January 2022 and April 2023. Patients were diagnosed using the International Society for Pediatric and Adolescent Diabetes 2022 guidelines.
Among the 112 patients included in the study, 41 (36.6%) were classified as mild, 42 (34.8%) as moderate and 32 (28.6%) as severe acidosis. A statistically significant difference was observed between the time to resolution and clinical severity of diabetic ketoacidosis (p < 0.001). Elevated lactate levels of 2.5 mmol/L or above were detected in 37.5% (42/112) of our patients and a significant increase in clinical severity was observed as lactate levels increased (p < 0.001). Correlation analysis revealed no significant relationship between lactate levels and time to resolution of diabetic ketoacidosis or length of intensive care unit stay. Multivariate analysis demonstrated a significant association between lactate levels and severity of acidosis (p: 0.046).
Although there is an association between the severity of acidosis and lactate levels in diabetic ketoacidosis, contrary to expectations, this relationship was not found to be associated with adverse outcomes. An important point not to be overlooked by pediatricians is that elevated lactate levels in diabetic ketoacidosis may not always herald poor outcomes.
血清乳酸水平已被公认为预测许多危重症儿童疾病严重程度和生存情况的可靠指标，但对于其在糖尿病酮症酸中毒中的作用，目前尚无共识。本研究旨在探讨糖尿病酮症酸中毒患儿初始乳酸水平与疾病严重程度之间的关系。
本单中心回顾性描述性研究纳入了2022年1月至2023年4月在儿科急诊科就诊的糖尿病酮症酸中毒患儿。采用国际儿童和青少年糖尿病学会2022年指南进行诊断。
在纳入研究的112例患者中，41例（36.6%）为轻度，42例（34.8%）为中度，32例（28.6%）为重度酸中毒。糖尿病酮症酸中毒的缓解时间与临床严重程度之间存在统计学显著差异（p<0.001）。我们的患者中有37.5%（42/112）检测到乳酸水平升高至2.5 mmol/L或以上，且随着乳酸水平升高，临床严重程度显著增加（p<0.001）。相关性分析显示，乳酸水平与糖尿病酮症酸中毒的缓解时间或重症监护病房住院时间之间无显著关系。多变量分析表明，乳酸水平与酸中毒严重程度之间存在显著关联（p：0.046）。
虽然糖尿病酮症酸中毒的酸中毒严重程度与乳酸水平之间存在关联，但与预期相反，未发现这种关系与不良结局相关。儿科医生不应忽视的一个重要点是，糖尿病酮症酸中毒中乳酸水平升高不一定总是预示着不良结局。
