Blanc N, Polak M, Czernichow P, Tubiana-Rufi N
Service d'endocrinologie et de diabétologie, hôpital Robert-Debré, Paris, France.
Arch Pediatr. 1997 Jun;4(6):550-4. doi: 10.1016/s0929-693x(97)87578-1.
In France, 48% of children with insulin-dependent diabetes mellitus (IDDM) are seen for the first time at the stage of keto-acidosis (DKA), a figure far higher than in other countries. The four consecutive cases reported in this paper suggest that severity at presentation is directly related to the delay of diagnosis.
All children, aged 6 to 11, presented with severe clinical and metabolic conditions: coma, hemodynamic failure, severe dehydration and acidosis (pH = 6.86 to 7.06). However, clinical symptoms were a present from 2 to 4 months, parents did not worry about them. Family practitioners visited 2-21 days before admission failed to immediately make the diagnosis of IDDM. True DKA was however present in all cases 48 hours prior to admission.
Earlier diagnosis of IDDM in children is necessary to reduce morbidity and mortality of DKA. General practitioners, pediatricians and emergency care practitioners must be made fully aware to consider diabetes in children and to use more extensively glucose-tests based on urine and blood strips.
在法国，48%的胰岛素依赖型糖尿病（IDDM）儿童首次就诊时处于酮症酸中毒（DKA）阶段，这一数字远高于其他国家。本文报告的连续4例病例表明，就诊时的严重程度与诊断延迟直接相关。
所有患儿年龄在6至11岁，均表现出严重的临床和代谢状况：昏迷、血流动力学衰竭、严重脱水和酸中毒（pH值=6.86至7.06）。然而，临床症状已出现2至4个月，家长却未对此担忧。入院前2至21天就诊的家庭医生未能立即诊断出IDDM。但所有病例在入院前48小时均已出现真正的DKA。
早期诊断儿童IDDM对于降低DKA的发病率和死亡率至关重要。必须让全科医生、儿科医生和急救医生充分意识到要考虑儿童患糖尿病的可能性，并更广泛地使用基于尿和血试纸的血糖检测。
