Pediatric:糖尿病酮症酸中毒患儿的血钠浓度与精神状态

2021-09-09 MedSci原创 MedSci原创

血钠浓度的下降与治疗期间的精神状态变化无关。

糖尿病酮症酸中毒 (DKA) 的典型特征是血钠浓度降低,随着高血糖的缓解,钠浓度会回升。既往的回顾性研究发现 DKA 期间的血钠浓度下降与脑损伤之间存在关联。这项发表在儿科学顶级期刊Pediatrics上的研究前瞻性分析了 DKA 期间血钠浓度变化的决定因素,以及与精神状态的相关性。

研究使用来自儿科急诊应用研究网络液体疗法糖尿病酮症酸中毒试验的数据,比较了葡萄糖校正的血钠浓度下降儿童与血钠浓度升高或稳定儿童。受试儿童被随机分为 4 种不同输液速度和钠含量的静脉输液方案。分别对1251、1086和 877 名患儿治疗前 4、8 和 12 小时的数据进行分析。

多因素分析中,葡萄糖校正的血钠浓度下降与就诊时钠和氯浓度升高以及先前诊断为糖尿病相关。使用0.45%氯化钠(vs 0.9%) 治疗也与血钠浓度下降有关;然而,输液速度快仅与血钠浓度在 12 小时内下降有关。血钠下降和没有下降患儿的格拉斯哥昏迷量表评分异常的发生率和脑损伤诊断率相似。

                             治疗开始12小时内血钠浓度降低vs.血钠浓度稳定的比值比

由此可见,DKA治疗期间血钠浓度的变化受游离水丢失与钠丢失平衡以及静脉输液钠含量的影响。血钠浓度的下降与治疗期间的精神状态变化无关。

 

原始出处:

Nicole S. Glaser. Serum Sodium Concentration and Mental Status in Children With Diabetic Ketoacidosis. Pediatric. September 2021.

 

 

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  5. 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  6. 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  7. 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    2021-09-11 mashirong

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Diabetes Care:新发或曾被诊断为1型糖尿病的儿童发生糖尿病酮症酸中毒后的认知功能

近日,一项随机的多地点临床试验评估了单次糖尿病酮症酸中毒(DKA)发作是否与新诊断的1型糖尿病儿童的认知能力下降有关,以及在考虑了血糖控制和其他相关因素的变化后,以前诊断过的儿童是否也是如此,研究结果

22岁女子长期过量喝奶茶被送进ICU!奶茶对人的危害有多大?

近日,湖南长沙,一22岁女子由于每天过量饮用奶茶,导致糖尿病酮症酸中毒突然昏迷,被送进ICU抢救。经过医护人员的全力救治,虽然这次死里逃生,但她将终身与胰岛素为伴。

糖尿病酮症酸中毒的精选要点,临床速用!

糖尿病酮症酸中毒是高血糖危象之一,也是糖尿病急性并发症之一,由于胰岛素不足或作用明显减弱和升糖激素不适当升高引起的糖、脂肪和蛋白代谢严重紊乱综合征

Diabetes Care:有饮食失调的T1DM患者的DKA和死亡风险分别增加了3倍和6倍!

与没有饮食失调病史的同龄人相比,有饮食失调病史的1型糖尿病青少年和年轻成人患者患DKA的风险增加了三倍以上,死亡风险增加了近六倍!

Diabetes Care:1型糖尿病青少年患者酮症酸中毒的发生率逐年增加!

从2010年至2016年,确诊为1型糖尿病或接近1型糖尿病的个体的DKA发生率逐年增加

JCEM:2006-2016年美国儿童糖尿病酮症酸中毒入院的全国趋势

美国儿童DKA入院率上升了40%,弱势群体风险最高。进一步的研究应归纳这些人群所面临的挑战,以为制定减轻其DKA风险的干预措施提供参考,并解决全国范围内DKA发生率上升的问题。