关于儿童糖尿病酮症酸中毒的叙述性综述。

IF 1.3 Q3 PEDIATRICS
Karen K Y Leung, Joanna Y L Tung, Yan Tung Kelly Lee, Stephanie Tsang, Kam Lun Hon
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引用次数: 0

摘要

背景:糖尿病酮症酸中毒(DKA)是儿童糖尿病患者的一种危及生命的并发症。不同国家对 DKA 的管理方法存在很大差异。指南之间存在差异的主要方面之一是输液,大多数指南都采取限制性方法。这是基于对脑水肿的担忧,据称过量输液会导致致命的后遗症。然而,近年来新的临床研究表明,静脉输液治疗与 DKA 相关脑损伤之间没有因果关系。英国儿科内分泌学会于 2020 年更新了指南,对输液采取了更为宽容的态度,这在一些儿科医生中引发了争议:本文旨在对 DKA 的管理进行叙述性综述:方法:使用关键词 "糖尿病酮症酸中毒 "进行PubMed临床检索。搜索策略包括随机对照试验、临床试验、荟萃分析、观察性研究、指南和综述。搜索仅限于英文文献,年龄范围为 18 岁及以下。此外,我们还对主要指南进行了回顾和比较:DKA 的治疗包括早期识别、准确诊断、精心输液和胰岛素治疗,以及密切监测血糖、酮体、电解质、肾功能和神经状态。在对儿科 DKA 患者进行输液管理时,支持限制性或允许性方法的临床证据仍然有限。临床医生在临床实践中应用不同的指南时应谨慎行事,并考虑到每个儿科患者的具体情况。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Narrative Review on Diabetic Ketoacidosis in Children.

Background: Diabetic ketoacidosis (DKA) is a life-threatening complication in children with diabetes mellitus. There are considerable differences in the management approaches for DKA between different countries. One of the main areas of differences between guidelines is the administration of fluid, with most guidelines adopting a restrictive approach. This is based on the concern over cerebral oedema, a lethal sequela allegedly to be caused by excessive fluid administration. However, in recent years, new clinical studies suggest that there is no causal relationship between intravenous fluid therapy and DKA-related cerebral injury. The British Society of Paediatric Endocrinology updated its guideline in 2020 to adopt a more permissive approach to fluid administration, which has sparked controversy among some paediatricians.

Objectives: The purpose of this article is to provide a narrative review on the management of DKA.

Methods: A PubMed search was performed with clinical queries using the key term "diabetic ketoacidosis". The search strategy included randomized controlled trials, clinical trials, meta-analyses, observational studies, guidelines, and reviews. The search was restricted to English literature and the age range of 18 years and younger. Moreover, we reviewed and compared major guidelines.

Conclusion: The management of DKA involves early recognition, accurate diagnosis, meticulous fluid and insulin treatment with close monitoring of blood glucose, ketones, electrolytes, renal function, and neurological status. There is still limited clinical evidence to support either a restrictive or permissive approach in the fluid management of paediatric DKA patients. Clinicians should exercise caution when applying different guidelines in their clinical practice, considering the specific circumstances of individual paediatric patients.

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来源期刊
CiteScore
4.30
自引率
0.00%
发文量
66
期刊介绍: Current Pediatric Reviews publishes frontier reviews on all the latest advances in pediatric medicine. The journal’s aim is to publish the highest quality review articles dedicated to clinical research in the field. The journal is essential reading for all researchers and clinicians in pediatric medicine.
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