Smedman L, Escobar R, Hesser U, Persson B
Department of Paediatrics, Karolinska Institute, Stockholm, Sweden.
Acta Paediatr. 1997 Nov;86(11):1172-6. doi: 10.1111/j.1651-2227.1997.tb14838.x.
Fulminant cerebral oedema is an uncommon, fatal complication of diabetic ketoacidosis (DKA) in children. This study aimed to find out whether the sub-clinical compression of the brain ventricles found by an earlier study, is a general phenomenon during intravenous treatment for DKA. Four boys and four girls were examined. Blood glucose values ranged from 40 to 24.6 mmol/l, base excess -34.6 to -13.6 and capillary blood pH 6.89-7.22. The patients received fluids containing both glucose and electrolytes, and insulin intravenously. After about 10h, blood glucose was 8.7-21.8 mmol/l and base excess had decreased substantially (-9.5 to -2.9) in seven of the eight cases. Computerized tomography of the brain was then performed, and again after full recovery. Only two of the patients had an initial decrease in intercaudate distance, which exceeded the variability found in a reference group. Compression of the cerebral ventricles does not occur regularly during treatment for DKA.
暴发性脑水肿是儿童糖尿病酮症酸中毒（DKA）一种罕见的致命并发症。本研究旨在查明早期研究发现的脑室亚临床受压情况在DKA静脉治疗期间是否为普遍现象。对4名男孩和4名女孩进行了检查。血糖值在40至24.6 mmol/L之间，碱剩余为-34.6至-13.6，毛细血管血pH值为6.89至7.22。患者静脉输注含葡萄糖和电解质的液体以及胰岛素。约10小时后，8例患者中有7例血糖为8.7至21.8 mmol/L，碱剩余大幅下降（从-9.5降至-2.9）。随后进行脑部计算机断层扫描，完全康复后再次扫描。只有2例患者最初尾状核间距离减小，超过了参考组的变异范围。DKA治疗期间脑室受压并非经常发生。
