Mel J M, Werther G A
Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia.
J Paediatr Child Health. 1995 Feb;31(1):17-20. doi: 10.1111/j.1440-1754.1995.tb02905.x.
Information regarding cerebral oedema in diabetic children with ketoacidosis does not point to any causal factor or any predictor of outcome. Cases of diabetic ketoacidosis resulting in cerebral oedema at Royal Children's Hospital, Melbourne, over the last 20 years were reviewed.
The study was divided into two 10-year periods during which different fluid protocols were used. During the earlier period dehydration was corrected rapidly (over six h) with a fluid isotonic for sodium. During the latter period rehydration was over 24 h using half-normal saline.
A similar number of patients developed cerebral oedema in the two periods (six of 3134 vs six of 3373). Only half of the patients (six) developed cerebral oedema during their initial presentation of diabetes mellitus. The age range was similar (1 to 15 years) with eight males and four females. Survival from cerebral oedema (four of 12) was not predicted by demographic or biochemical findings, including initial biochemistry, age, duration of ketoacidosis and the management protocols.
This study suggests that the rate of salt and water replacement in diabetic ketoacidosis are not key determinants of the appearance of cerebral oedema. No factors predictive of survival from cerebral oedema have been identified, though this is a rare entity and case numbers were small. Nevertheless, current protocols at Royal Children's Hospital and most other centres utilize slow rates of rehydration with isotonic saline fluids. Further review in 5-10 years may determine whether this protocol is effective in reducing rates of cerebral oedema complicating diabetic ketoacidosis.
有关糖尿病酮症酸中毒患儿脑水肿的信息并未指向任何因果因素或预后预测指标。对墨尔本皇家儿童医院过去20年中导致脑水肿的糖尿病酮症酸中毒病例进行了回顾。
该研究分为两个10年期，在此期间使用了不同的补液方案。在早期，用等渗钠溶液在6小时内迅速纠正脱水。在后期，使用半张生理盐水在24小时内进行补液。
两个时期发生脑水肿的患者数量相似（3134例中有6例，3373例中有6例）。只有一半的患者（6例）在糖尿病初次发作时发生脑水肿。年龄范围相似（1至15岁），男性8例，女性4例。脑水肿的存活情况（12例中有4例）无法通过人口统计学或生化检查结果预测，包括初始生化指标、年龄、酮症酸中毒持续时间和治疗方案。
本研究表明，糖尿病酮症酸中毒时盐和水的补充速度不是脑水肿发生的关键决定因素。尚未确定可预测脑水肿存活情况的因素，尽管这是一种罕见情况且病例数量较少。然而，皇家儿童医院和大多数其他中心目前的治疗方案采用等渗盐溶液缓慢补液。5至10年后的进一步回顾可能会确定该方案是否能有效降低糖尿病酮症酸中毒并发脑水肿的发生率。
