Nigrovic Lise E, Kuppermann Nathan, Ghetti Simona, Schunk Jeff E, Stoner Michael J, Rewers Arleta, McManemy Julie K, Quayle Kimberly S, Trainor Jennifer L, Tzimenatos Leah, Bennett Jonathan E, Kwok Maria Y, Myers Sage R, Brown Kathleen M, Casper T Charles, Olsen Cody S, Glaser Nicole S
Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Emergency Medicine, University of California Davis Health, School of Medicine, Sacramento, CA, USA.
Pediatr Diabetes. 2023 Sep 20;2023:6693226. doi: 10.1155/2023/6693226. eCollection 2023.
Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of childhood diabetes. However, the influence of demographic factors on presentation are not well-defined.
We included children from 12 centers who were <18 years with DKA (glucose > 300 mg/dL, serum pH < 7.25, or serum bicarbonate <15 mEq/L) enrolled in the Pediatric Emergency Care Applied Research Network (PECARN) Fluid Therapies Under Investigation in DKA (FLUID) Trial. Data were also collected for children who presented to the centers during the enrollment period but were not enrolled due to disease or treatment-related reasons. We compared demographic, clinical, and biochemical findings among children with newly and previously diagnosed diabetes and children in different age groups.
Of the 1,679 DKA episodes in 1,553 children, 799 (47.5%) episodes occurred in children with newly diagnosed diabetes and 396 (23.6%) were severe (pH < 7.1). Newly diagnosed children <6 years of age were not more likely to have severe DKA in terms of pH, but had more severe hypocarbia and higher blood urea nitrogen levels, factors previously associated with the risk of cerebral injury. Lower socioeconomic status (SES) (based on family income and maternal education level) were associated with more severe DKA in new onset children, and recurrent DKA in the previously diagnosed children.
Greater efforts are needed to identify the children with diabetes early and to prevent recurrent DKA, particularly among children in low-SES groups. Young children with DKA may need more intensive monitoring due to higher risk of cerebral injury.
糖尿病酮症酸中毒（DKA）是儿童糖尿病一种可能危及生命的并发症。然而，人口统计学因素对其临床表现的影响尚不明确。
我们纳入了来自12个中心的18岁以下患有DKA（血糖>300mg/dL、血清pH<7.25或血清碳酸氢盐<15mEq/L）的儿童，这些儿童参与了儿科急诊护理应用研究网络（PECARN）的DKA液体疗法研究（FLUID）试验。我们还收集了在入组期间到这些中心就诊但因疾病或治疗相关原因未入组儿童的数据。我们比较了新诊断和既往诊断糖尿病儿童以及不同年龄组儿童的人口统计学、临床和生化检查结果。
在1553名儿童的1679次DKA发作中，799次（47.5%）发作发生在新诊断糖尿病儿童中，396次（23.6%）为重度发作（pH<7.1）。新诊断的6岁以下儿童在pH方面发生重度DKA的可能性并不更高，但有更严重的低碳酸血症和更高的血尿素氮水平，这些因素之前与脑损伤风险相关。较低的社会经济地位（基于家庭收入和母亲教育水平）与新发病儿童中更严重的DKA以及既往诊断儿童中的复发性DKA相关。
需要做出更大努力来早期识别糖尿病儿童并预防DKA复发，尤其是在低社会经济地位群体的儿童中。患有DKA的幼儿可能因脑损伤风险较高而需要更密切的监测。
