DIJABETESNA KETOACIDOZA – NAŠA ISKUSTVA
Ključne reči:
deca, dijabetes melitus tip 1, dijabetesna ketoacidoza
Sažetak
Dijabetesna ketoacidoza je akutna komplikacija kod dece obolele od dijabetes melitusa tip 1. Definiše se kao vrednost šećera > 11 mmol / l, pH < 7,3, HCO3- ≤ 15 mmol / l, uz ketonemiju ili ketonuriju. Podela na osnovu vrednosti pH i bikarbonata u serumu je na blagu, umerenu i tešku. Manifestuje se ubrzanim disanjem, bolovima u stomaku, mučninom, povraćanjem, izmenjenim stanjem svesti. Rano prepoznavanje simptoma sprečava mogućnost nastajanja ozbiljnih komplikacija. Lečenje obuhvata nadoknadu tečnosti, korekciju dehidracije, terapiju insulinom, nadoknadu elektrolita, korekciju glukoze.
U ovom radu prikazani su pacijenti ženskog pola, uzrasta od 2,5 do 15,3 godina sa različitom simptomatologijom. Klinički nalazi i rezultati laboratorijskih pretraga ukazivali su na dijabetesnu ketoacidozu. Nakon započinjanja urgentne terapije upućeni su u jedinice intenzivne nege, tercijarnih centara gde je zaključeno da je posledica nastalog stanja novootkrieni dijabetes melitus tip 1.
Ovakvi pacijenti zahtevaju rano prepoznavanje simptoma, urgentno zbrinjavanje i tretman u jedinicama intenzivne nege, kako bi se sprečile moguće komplikacije.
Reference
1. Guidelines Update Team (UK). Evidence reviews for fluid therapy for the management of diabetic ketoacidosis: Diabetes (type 1 and type 2) in children and young people: diagnosis and management: Evidence review A. London: National Institute for Health and Care Excellence (UK); 2020. PMID: 33378145.
2. Wolfsdorf JI, Glaser N, Agus M, Fritsch M, Hanas R, Rewers A, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes. 2018;19 Suppl 27:155-177. doi: 10.1111/pedi.12701. PMID: 29900641.
3. McGregor S, Metzger DL, Amed S, Goldman RD. Fluid management in children with diabetic ketoacidosis. Can Fam Physician. 2020;66(11):817-819.
4. Dhatariya KK, Glaser NS, Codner E, Umpierrez GE. Diabetic ketoacidosis. Nat Rev Dis Primers. 2020;6(1):40. doi: 10.1038/s41572-020-0165-1. PMID: 32409703.
5. Große J, Hornstein H, Manuwald U, Kugler J, Glauche I, Rothe U. Incidence of Diabetic Ketoacidosis of New-Onset Type 1 Diabetes in Children and Adolescents in Different Countries Correlates with Human Development Index (HDI): An Updated Systematic Review, Meta-Analysis, and Meta-Regression. Horm Metab Res. 2018;50(3):209-222. doi: 10.1055/s-0044-102090. Epub 2018. Erratum in: Horm Metab Res. 2018 Mar;50(3):e2. PMID: 29523007.
6. Cherubini V, Grimsmann JM, Åkesson K, Birkebæk NH, Cinek O, Dovč K, et al. Temporal trends in diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes between 2006 and 2016: results from 13 countries in three continents. Diabetologia. 2020;63(8):1530-1541. doi: 10.1007/s00125-020-05152-1. Epub 2020 May 8. PMID: 32382815; PMCID: PMC7351855.
7. Vukovic R, Jesic MD, Vorgucin I, Stankovic S, Folic N, Milenkovic T, et al. First report on the nationwide incidence of type 1 diabetes and ketoacidosis at onset in children in Serbia: a multicenter study. Eur J Pediatr. 2018;177(8):1155-1162. doi: 10.1007/s00431-018-3172-4. Epub 2018 May 17. PMID: 29774417.
8. Stankovic S, Vukovic R, Vorgucin I, Zdravkovic V, Folic N, Zivic S, et al. First report on the nationwide prevalence of paediatric type 1 diabetes in Serbia and temporal trends of diabetes ketoacidosis at diagnosis-a multicentre study. J Pediatr Endocrinol Metab. 2020;34(2):225-229. doi: 10.1515/jpem-2020-0405. PMID: 33544544.
9. Martínez E, Portillo N, Lizarralde E, Grau G, Vela A, Rodríguez A, et al. For Debate: Paediatric T1DM: DKA is Still a Problem. Pediatr Endocrinol Rev. 2018;16(2):233-239. doi: 10.17458/per.vol16.2018.mpr.fd.t1dmdka. PMID: 30556656.
10. Manuwald U, Schoffer O, Hegewald J, Große J, Kugler J, Kapellen TM, et al. Ketoacidosis at onset of type 1 diabetes in children up to 14 years of age and the changes over a period of 18 years in Saxony, Eastern-Germany: A population based register study. PLoS One. 2019;14(6):e0218807. doi: 10.1371/journal.pone.0218807. PMID: 31220176; PMCID: PMC6586407.
11. Kao KT, Islam N, Fox DA, Amed S. Incidence Trends of Diabetic Ketoacidosis in Children and Adolescents with Type 1 Diabetes in British Columbia, Canada. J Pediatr. 2020;221:165-173.e2. doi: 10.1016/j.jpeds.2020.02.069. PMID: 32446476.
12. Lawrence C, Seckold R, Smart C, King BR, Howley P, Feltrin R, et al. Increased paediatric presentations of severe diabetic ketoacidosis in an Australian tertiary centre during the COVID-19 pandemic. Diabet Med. 2021;38(1):e14417. doi: 10.1111/dme.14417. Epub 2020. PMID: 33020999; PMCID: PMC7646057.
13. Elbarbary NS, Dos Santos TJ, de Beaufort C, Agwu JC, Calliari LE, Scaramuzza AE. COVID-19 outbreak and pediatric diabetes: Perceptions of health care professionals worldwide. Pediatr Diabetes. 2020;21(7):1083-1092. doi: 10.1111/pedi.13084. Epub 2020 Aug 17. PMID: 32686287; PMCID: PMC7404589.
14. Del Pozo P, Aránguiz D, Córdova G, Scheu C, Valle P, Cerda J, et al. Clinical profile of children with diabetic ketoacidosis in fifteen years of management in a Critical Care Unit. Rev Chil Pediatr. 2018;89(4):491-498. English, Spanish. doi: 10.4067/S0370-41062018005000703. PMID: 30571823.
15. Burcul I, Arambasic N, Polic B, Kovacevic T, Bartulovic I, Catipovic Ardalic T, et al. Characteristics of Children with Diabetic Ketoacidosis Treated in Pediatric Intensive Care Unit: Two-Center Cross-Sectional Study in Croatia. Medicina (Kaunas). 2019;55(7):362. doi: 10.3390/medicina55070362. PMID: 31295949; PMCID: PMC6681342.
16. Jackman J, Chafe R, Albrechtsons D, Porter R, Nugent C, Waheed S, et al. Delayed diagnosis and issues with pump usage are the leading causes of diabetic ketoacidosis in children with diabetes living in Newfoundland and Labrador, Canada. BMC Res Notes. 2015;8:158. doi: 10.1186/s13104-015-1115-y. PMID: 25889476; PMCID: PMC4407332.
17. Iovane B, Cangelosi AM, Bonaccini I, Di Mauro D, Scarabello C, Panigari A, et al. Diabetic ketoacidosis at the onset of Type 1 diabetes in young children Is it time to launch a tailored campaign for DKA prevention in children <5 years? Acta Biomed. 2018;89(1):67-71. doi: 10.23750/abm.v89i1.6936. PMID: 29633745; PMCID: PMC6357617.
18. Szypowska A, Dżygało K, Wysocka-Mincewicz M, Mazur A, Lisowicz L, Ben-Skowronek I, et al. High incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes among Polish children aged 10-12 and under 5 years of age: A multicenter study. Pediatr Diabetes. 2017;18(8):722-728. doi: 10.1111/pedi.12446. Epub 2016 Oct 11. PMID: 27726262.
19. Choleau C, Maitre J, Filipovic Pierucci A, Elie C, Barat P, Bertrand AM, et al; AJD Study Group. Ketoacidosis at diagnosis of type 1 diabetes in French children and adolescents. Diabetes Metab. 2014;40(2):137-42. doi: 10.1016/j.diabet.2013.11.001. Epub 2013 Dec 11. PMID: 24332018.
20. Bergmann KR, Whitcomb V. Ventricular tachycardia in an adolescent with severe diabetic ketoacidosis. Am J Emerg Med. 2020:S0735-6757(20)31148-7. doi: 10.1016/j.ajem.2020.12.029. Epub ahead of print. PMID: 33376006.
21. Shah N, Khadilkar V, Khadilkar A, Jahagirdar R. Intussusception as a rare clinical presentation of a child with type 1 diabetes and diabetic ketoacidosis. BMJ Case Rep. 2020;13(12):e237229. doi: 10.1136/bcr-2020-237229. PMID: 33298484; PMCID: PMC7733091.
2. Wolfsdorf JI, Glaser N, Agus M, Fritsch M, Hanas R, Rewers A, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes. 2018;19 Suppl 27:155-177. doi: 10.1111/pedi.12701. PMID: 29900641.
3. McGregor S, Metzger DL, Amed S, Goldman RD. Fluid management in children with diabetic ketoacidosis. Can Fam Physician. 2020;66(11):817-819.
4. Dhatariya KK, Glaser NS, Codner E, Umpierrez GE. Diabetic ketoacidosis. Nat Rev Dis Primers. 2020;6(1):40. doi: 10.1038/s41572-020-0165-1. PMID: 32409703.
5. Große J, Hornstein H, Manuwald U, Kugler J, Glauche I, Rothe U. Incidence of Diabetic Ketoacidosis of New-Onset Type 1 Diabetes in Children and Adolescents in Different Countries Correlates with Human Development Index (HDI): An Updated Systematic Review, Meta-Analysis, and Meta-Regression. Horm Metab Res. 2018;50(3):209-222. doi: 10.1055/s-0044-102090. Epub 2018. Erratum in: Horm Metab Res. 2018 Mar;50(3):e2. PMID: 29523007.
6. Cherubini V, Grimsmann JM, Åkesson K, Birkebæk NH, Cinek O, Dovč K, et al. Temporal trends in diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes between 2006 and 2016: results from 13 countries in three continents. Diabetologia. 2020;63(8):1530-1541. doi: 10.1007/s00125-020-05152-1. Epub 2020 May 8. PMID: 32382815; PMCID: PMC7351855.
7. Vukovic R, Jesic MD, Vorgucin I, Stankovic S, Folic N, Milenkovic T, et al. First report on the nationwide incidence of type 1 diabetes and ketoacidosis at onset in children in Serbia: a multicenter study. Eur J Pediatr. 2018;177(8):1155-1162. doi: 10.1007/s00431-018-3172-4. Epub 2018 May 17. PMID: 29774417.
8. Stankovic S, Vukovic R, Vorgucin I, Zdravkovic V, Folic N, Zivic S, et al. First report on the nationwide prevalence of paediatric type 1 diabetes in Serbia and temporal trends of diabetes ketoacidosis at diagnosis-a multicentre study. J Pediatr Endocrinol Metab. 2020;34(2):225-229. doi: 10.1515/jpem-2020-0405. PMID: 33544544.
9. Martínez E, Portillo N, Lizarralde E, Grau G, Vela A, Rodríguez A, et al. For Debate: Paediatric T1DM: DKA is Still a Problem. Pediatr Endocrinol Rev. 2018;16(2):233-239. doi: 10.17458/per.vol16.2018.mpr.fd.t1dmdka. PMID: 30556656.
10. Manuwald U, Schoffer O, Hegewald J, Große J, Kugler J, Kapellen TM, et al. Ketoacidosis at onset of type 1 diabetes in children up to 14 years of age and the changes over a period of 18 years in Saxony, Eastern-Germany: A population based register study. PLoS One. 2019;14(6):e0218807. doi: 10.1371/journal.pone.0218807. PMID: 31220176; PMCID: PMC6586407.
11. Kao KT, Islam N, Fox DA, Amed S. Incidence Trends of Diabetic Ketoacidosis in Children and Adolescents with Type 1 Diabetes in British Columbia, Canada. J Pediatr. 2020;221:165-173.e2. doi: 10.1016/j.jpeds.2020.02.069. PMID: 32446476.
12. Lawrence C, Seckold R, Smart C, King BR, Howley P, Feltrin R, et al. Increased paediatric presentations of severe diabetic ketoacidosis in an Australian tertiary centre during the COVID-19 pandemic. Diabet Med. 2021;38(1):e14417. doi: 10.1111/dme.14417. Epub 2020. PMID: 33020999; PMCID: PMC7646057.
13. Elbarbary NS, Dos Santos TJ, de Beaufort C, Agwu JC, Calliari LE, Scaramuzza AE. COVID-19 outbreak and pediatric diabetes: Perceptions of health care professionals worldwide. Pediatr Diabetes. 2020;21(7):1083-1092. doi: 10.1111/pedi.13084. Epub 2020 Aug 17. PMID: 32686287; PMCID: PMC7404589.
14. Del Pozo P, Aránguiz D, Córdova G, Scheu C, Valle P, Cerda J, et al. Clinical profile of children with diabetic ketoacidosis in fifteen years of management in a Critical Care Unit. Rev Chil Pediatr. 2018;89(4):491-498. English, Spanish. doi: 10.4067/S0370-41062018005000703. PMID: 30571823.
15. Burcul I, Arambasic N, Polic B, Kovacevic T, Bartulovic I, Catipovic Ardalic T, et al. Characteristics of Children with Diabetic Ketoacidosis Treated in Pediatric Intensive Care Unit: Two-Center Cross-Sectional Study in Croatia. Medicina (Kaunas). 2019;55(7):362. doi: 10.3390/medicina55070362. PMID: 31295949; PMCID: PMC6681342.
16. Jackman J, Chafe R, Albrechtsons D, Porter R, Nugent C, Waheed S, et al. Delayed diagnosis and issues with pump usage are the leading causes of diabetic ketoacidosis in children with diabetes living in Newfoundland and Labrador, Canada. BMC Res Notes. 2015;8:158. doi: 10.1186/s13104-015-1115-y. PMID: 25889476; PMCID: PMC4407332.
17. Iovane B, Cangelosi AM, Bonaccini I, Di Mauro D, Scarabello C, Panigari A, et al. Diabetic ketoacidosis at the onset of Type 1 diabetes in young children Is it time to launch a tailored campaign for DKA prevention in children <5 years? Acta Biomed. 2018;89(1):67-71. doi: 10.23750/abm.v89i1.6936. PMID: 29633745; PMCID: PMC6357617.
18. Szypowska A, Dżygało K, Wysocka-Mincewicz M, Mazur A, Lisowicz L, Ben-Skowronek I, et al. High incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes among Polish children aged 10-12 and under 5 years of age: A multicenter study. Pediatr Diabetes. 2017;18(8):722-728. doi: 10.1111/pedi.12446. Epub 2016 Oct 11. PMID: 27726262.
19. Choleau C, Maitre J, Filipovic Pierucci A, Elie C, Barat P, Bertrand AM, et al; AJD Study Group. Ketoacidosis at diagnosis of type 1 diabetes in French children and adolescents. Diabetes Metab. 2014;40(2):137-42. doi: 10.1016/j.diabet.2013.11.001. Epub 2013 Dec 11. PMID: 24332018.
20. Bergmann KR, Whitcomb V. Ventricular tachycardia in an adolescent with severe diabetic ketoacidosis. Am J Emerg Med. 2020:S0735-6757(20)31148-7. doi: 10.1016/j.ajem.2020.12.029. Epub ahead of print. PMID: 33376006.
21. Shah N, Khadilkar V, Khadilkar A, Jahagirdar R. Intussusception as a rare clinical presentation of a child with type 1 diabetes and diabetic ketoacidosis. BMJ Case Rep. 2020;13(12):e237229. doi: 10.1136/bcr-2020-237229. PMID: 33298484; PMCID: PMC7733091.
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2022/02/08
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