Hoffman W H, Locksmith J P, Burton E M, Hobbs E, Passmore G G, Pearson-Shaver A L, Deane D A, Beaudreau M, Bassali R W
Department of Pediatrics, Medical College of Georgia, Augusta 30912, USA.
J Diabetes Complications. 1998 Nov-Dec;12(6):314-20. doi: 10.1016/s1056-8727(98)00012-9.
The acute complications of diabetic ketoacidosis in children and adolescents are well recognized but not completely understood. Clinical studies have focused primarily on brain edema. We have investigated the prevalence and course of interstitial pulmonary edema in patients with severe diabetic ketoacidosis all of whom had uneventful clinical courses. High resolution computed tomography scans of the lungs were analyzed by determining the Hounsfield attenuation level and then converting to physical density values. All seven patients had evidence of interstitial pulmonary edema on the first scan, which was performed within 1 h of hydration and prior to receiving insulin; six of the seven patients had increased pulmonary density 6-8 h into treatment, and all had complete resolution of the interstitial changes at discharge. Our study suggests that subclinical interstitial pulmonary edema may be a frequent occurrence in children and adolescents with severe diabetic ketoacidosis and may very well be present prior to treatment. The study also supports the philosophy of cautious rehydration and the close monitoring of children and adolescents with diabetic ketoacidosis until a more complete understanding of this pathophysiologic event is achieved.
儿童和青少年糖尿病酮症酸中毒的急性并发症已广为人知，但尚未完全了解。临床研究主要集中在脑水肿方面。我们调查了患有严重糖尿病酮症酸中毒患者的间质性肺水肿的患病率和病程，所有患者的临床病程均平稳。通过确定亨氏衰减水平，然后转换为物理密度值，对肺部的高分辨率计算机断层扫描进行分析。所有7例患者在首次扫描时均有间质性肺水肿的证据，该扫描在补液后1小时内且在接受胰岛素治疗之前进行；7例患者中有6例在治疗6 - 8小时后肺部密度增加，所有患者在出院时间质改变均完全消退。我们的研究表明，亚临床间质性肺水肿在患有严重糖尿病酮症酸中毒的儿童和青少年中可能经常发生，并且很可能在治疗前就已存在。该研究还支持谨慎补液的理念以及对糖尿病酮症酸中毒儿童和青少年进行密切监测，直到对这一病理生理事件有更全面的了解。
