DIABETIC KETOACIDOSIS IN CHILDREN

摘要

Diabetic ketoacidosis (DKA) is a serious and emergent, acute complication of diabetes, caused by insulin deficiency. The lack of insulin results in a catabolic state, with endogenous glucose production, proteolysis, and lipolysis. Metabolic acidosis develops as a result of lipolysis and the formation of ketone bodies in the absence of glucose availability in insulin dependent tissues. DKA is the leading cause of morbidity and mortality in youth with type 1 diabetes. It can occur in youth with type 2diabetes as well, although this is less common, as a result of an absolute or relative deficiency of insulin. The following represent the biochemical criteria for the diagnosis of DKA:-Hyperglycemia, blood glucose of >200 mg/dL (11 mmol/L) AND-Metabolic acidosis, defined as a venous pH <7.3 or plasma bicarbonate <15 mEq/L (15 mmol/L) AND-Ketosis, determined by the presence of ketones in the blood or urine. Hyperosmolar hyperglycemic state (HHS)~3 is a serious and emergent, acute complication of diabetes which is distinguished from DKA by marked hyperglycemia (plasma glucose >600 mg/dL [>33.3 mmol/L]) but with minimal or only mild acidosis (serum bicarbonate >15 mmol/L, venous pH >7.25 or arterial pH >7.30). There is an absence of ketosis, and only small ketonuria. The extreme dehydration and hyperosmolar state (effective serum osmolality >320 mOsm/L) leads to symptoms and altered consciousness. HHS is reported mainly among black adolescents with type 2 diabetes, but has occurred in whites and other race/ethnicity groups as well.