Rosenbloom A L, Hanas R
Department of Pediatrics, University of Florida College of Medicine, Gainesville 32610-0296, USA.
Clin Pediatr (Phila). 1996 May;35(5):261-6. doi: 10.1177/000992289603500506.
Diabetic ketoacidosis (DKA), resulting from severe insulin deficiency, accounts for most hospitalization and is the most common cause of death, mostly due to cerebral edema, in pediatric diabetes. This article provides guidelines on management to restore perfusion, stop ongoing ketogenesis, correct electrolyte losses, and avoid hypokalemia and hypoglycemia and the circumstances that may contribute, in some instances, to cerebral edema (overhydration, rapid osmolar shifts, hypoxia). These guidelines emphasize the importance of monitoring glycemia, electrolytes, hydration, vital signs, and neurologic status in a setting where response can be rapid if necessary (e.g., mannitol for cerebral edema). Most important is the prevention of DKA in established patients by close supervision of those most likely to omit insulin, or during illness, and a high index of suspicion for diabetes to prevent deterioration to DKA in new patients, particularly those under age 5, who are at greatest risk of complications.
糖尿病酮症酸中毒（DKA）由严重胰岛素缺乏引起，是小儿糖尿病患者住院的主要原因，也是最常见的死亡原因，主要死于脑水肿。本文提供了治疗指南，以恢复灌注、停止持续的酮体生成、纠正电解质丢失、避免低钾血症和低血糖，以及避免在某些情况下可能导致脑水肿的情况（过度水化、快速渗透压变化、缺氧）。这些指南强调在必要时能够迅速做出反应的环境中监测血糖、电解质、水化状态、生命体征和神经状态的重要性（例如，使用甘露醇治疗脑水肿）。最重要的是，通过密切监督最有可能漏用胰岛素的患者，或在患病期间密切监督，以及对糖尿病保持高度怀疑指数，以防止新患者，特别是5岁以下并发症风险最高的患者病情恶化为DKA，从而预防DKA在已确诊患者中的发生。
