Clinical analysis of 20 cases of brain injury caused by diabetic ketoacidosis in children.

IF 2 3区医学 Q2 PEDIATRICS

BMC Pediatrics Pub Date : 2025-07-23 DOI:10.1186/s12887-025-05927-8

Bin Zhou, Weiwei Chen, Shengxin Zhang, Yukun Huang, Chunzhi Chen, Yali Cai

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Abstract

Objective: To analyse clinical features and identify risk factors for brain injury in paediatric diabetic ketoacidosis (DKA), aiming to support early recognition and intervention.

Methods: A retrospective study was conducted on 20 children with DKA-related brain injury and 14 children with DKA without brain injury admitted to Xiamen Children's Hospital between January 2022 and April 2024. Clinical data, laboratory findings, electroencephalography and magnetic resonance imaging (MRI) results were reviewed. Logistic regression analyses were used to identify influencing factors.

Results: Among the 20 children with DKA-related brain injury, 75% were girls, the median age was 7.3 years and 70% had severe DKA. Impaired consciousness was the primary symptom, presenting as lethargy (75%), dizziness (10%), somnolence (10%) and delirium (5%). Electroencephalography abnormalities were observed in 8 cases, and MRI changes were noted in 3 cases. Multivariate analysis identified a longer time to blood glucose stabilisation (odds ratio [OR] = 1.047, 95% confidence interval [CI]: 1.014-1.080, P = 0.005) and elevated insulin levels (OR = 1.217, 95% CI: 1.048-1.413, P = 0.010) as independent risk factors. Higher pH (OR = 0.002, P = 0.003), partial pressure of carbon dioxide (OR = 0.790, P = 0.007), serum bicarbonate (OR = 0.836, P = 0.010) and base excess (OR = 0.665, P = 0.015) were found to be protective.

Conclusions: Brain injury in paediatric DKA is associated with delayed metabolic correction. Early monitoring and timely regulation of acid-base balance and glucose levels may reduce the risk and improve outcomes.

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糖尿病酮症酸中毒致儿童脑损伤20例临床分析。

目的：分析小儿糖尿病酮症酸中毒（DKA）脑损伤的临床特点及危险因素，为早期识别和干预提供依据。方法：回顾性分析厦门市儿童医院2022年1月至2024年4月收治的20例DKA相关脑损伤患儿和14例无脑损伤DKA患儿。本文回顾了临床资料、实验室结果、脑电图和磁共振成像（MRI）结果。采用Logistic回归分析确定影响因素。结果：20例DKA相关脑损伤患儿中，女孩占75%，中位年龄7.3岁，重度DKA患儿占70%。意识受损是主要症状，表现为嗜睡（75%）、头晕（10%）、嗜睡（10%）和谵妄（5%）。脑电图异常8例，MRI改变3例。多因素分析发现，较长的血糖稳定时间（优势比[OR] = 1.047, 95%可信区间[CI]: 1.014-1.080, P = 0.005）和胰岛素水平升高（OR = 1.217, 95% CI: 1.048-1.413, P = 0.010）是独立的危险因素。较高的pH值（OR = 0.002, P = 0.003）、二氧化碳分压（OR = 0.790, P = 0.007）、血清碳酸氢盐（OR = 0.836, P = 0.010）和碱过量（OR = 0.665, P = 0.015）具有保护作用。结论：儿童DKA的脑损伤与延迟代谢纠正有关。早期监测和及时调节酸碱平衡和血糖水平可以降低风险，改善预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMC Pediatrics PEDIATRICS-

CiteScore

3.70

自引率

4.20%

发文量

683

审稿时长

3-8 weeks

期刊介绍： BMC Pediatrics is an open access journal publishing peer-reviewed research articles in all aspects of health care in neonates, children and adolescents, as well as related molecular genetics, pathophysiology, and epidemiology.