Lazar L, Erez I, Gutermacher M, Katz S
Department of Pediatric Surgery, Meir General Hospital, Sapir Medical Center, Kfar Saba, Israel.
J Pediatr Surg. 1997 Jan;32(1):88-90. doi: 10.1016/s0022-3468(97)90102-0.
Hyperglycemia and hypokalemia caused by catecholamine discharge have been reported to occur in patients after severe head trauma. The aim of this prospective study was to evaluate whether a similar neuroendocrine and metabolic response is found in children after minor head trauma such as brain concussion (Glasgow Coma Scale (GCS) > or = 13). One hundred fifty patients aged 2 to 14 years (average, 6 years) were divided into three groups (n = 50 in each group). Group 1 included patients admitted to the emergency department for brain concussion (Glasgow Coma Scale (GCS) > or = 13); group 2 included patients admitted for fractures of long bones without head injury; and group 3 were control patients electively admitted for hernia repair. All patients had complete physical and neurological examinations. Complete blood count and blood chemistry were obtained on admission. All blood tests were repeated at 6, 12, and 24 hours in patients belonging to group 1. An electrocardiogram was obtained in selected patients and catecholamine levels were measured in some patients. Statistical analysis was performed using analysis of variance (ANOVA). Serum potassium and sodium levels in patients with brain concussion (group 1) were 3.6 +/- 0.6 and 136 +/- 3 mEq/L, respectively and were significantly lower (P < 0.01) than those in patients belonging to group 2, 4 +/- 0.4 and 138 +/- 3, respectively, and the controls (group 3), 4.2 +/- 0.5 and 140 +/- 2, respectively. Serum glucose level was 124 +/- 34 and 118 +/- 32 mg% in groups 1 and 2 and was significantly higher than that of the controls (group 3), 90 +/- 23 mg%. There was no correlation between serum electrolytes and GCS. No electrocardiogram changes or elevation of serum catecholamines were found. Hypokalemia resolved spontaneously within 24 hours. All patients recovered without neurological sequalae. Transient hypokalemia frequently occurs in children even with minor head trauma. This hypokalemia resolves spontaneously, without treatment and within 24 hours.
据报道，严重颅脑外伤患者会出现由儿茶酚胺释放引起的高血糖和低钾血症。这项前瞻性研究的目的是评估在轻度颅脑外伤（如脑震荡，格拉斯哥昏迷量表（GCS）≥13）后的儿童中是否会出现类似的神经内分泌和代谢反应。150名年龄在2至14岁（平均6岁）的患者被分为三组（每组n = 50）。第一组包括因脑震荡入住急诊科的患者（格拉斯哥昏迷量表（GCS）≥13）；第二组包括因长骨骨折但无头部损伤而入院的患者；第三组是择期入院进行疝气修补的对照患者。所有患者均进行了全面的体格检查和神经系统检查。入院时进行了全血细胞计数和血液化学检查。第一组患者在6、12和24小时重复进行了所有血液检查。对部分患者进行了心电图检查，并对部分患者测量了儿茶酚胺水平。采用方差分析（ANOVA）进行统计分析。脑震荡患者（第一组）的血清钾和钠水平分别为3.6±0.6和136±3 mEq/L，明显低于第二组患者（分别为4±0.4和138±3）以及对照组（第三组，分别为4.2±0.5和140±2）（P < 0.01）。第一组和第二组的血清葡萄糖水平分别为124±34和118±32 mg%，明显高于对照组（第三组，90±23 mg%）。血清电解质与GCS之间无相关性。未发现心电图变化或血清儿茶酚胺升高。低钾血症在24小时内自行缓解。所有患者均康复，无神经后遗症。即使是轻度颅脑外伤的儿童也经常会出现短暂性低钾血症。这种低钾血症无需治疗，会在24小时内自行缓解。
