Diyabetik ketoasidozla başvuran çocukların klinik ve laboratuvar özellikleri
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Date
2008
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Uludağ Üniversitesi
Abstract
Amaç: Diyabetik ketoasidoz (DKA) tip 1 diabetes mellituslu (T1DM) çocuklarda önemli ölçüde mortalite ve morbiditeye neden olan ciddi bir durumdur. Çocuklarda DKA nedeniyle hastaneye yatış tüm hastane yatışlarının %2’si ile %8’i arasındadır. Yeni T1DM tanılı hastaların ortalama %25’i DKA ile başvururlar. Bu çalışmada DKA ile başvuran T1DM’li çocukların sosyodemografik ve klinik özelliklerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Ocak 2003 ile Ekim 2008 tarihleri arasındaki yaklaşık 6 yıllık süre içerisinde kliniğimize T1DM tanısıyla yatırılan 490 hastanın dosyası geriye dönük olarak incelenerek DKA tanısı alan 163 hastanın sosyodemografik özellikleriyle klinik ve laboratuvar bulguları ayrıntılı olarak gözden geçirilmiştir. Bulgular: T1DM ile kliniğimize yatırılan olguların %33,2’sinin DKA ile başvurduğu ve toplam DKA atak sayısının 190 olduğu saptanmıştır. Olguların yaş ortalaması 11,02±4,57 yıl, DKA’nın en sık görüldüğü yaşlar 10-15 (%39,3) yaş grubu, en nadir görüldüğü yaşlar ise 0-5 (%16,0) yaş grubu olarak bulunmuştur. Tekrarlayan atak oranı %14,2 olup tekrarlayan atağı olan olguların %85’i (6/7) kızdır. DKA ataklarının Ocak-Mart ve Eylül-Kasım dönemlerinde zirve yaptığı tespit edilmiştir. Ağır DKA ile başvuru en fazla (%54,5) 0-5 yaş grubunda görülmüştür. Asidozdan ortalama çıkma süresi 14,29±12,14 saat, ortalama kan şekeri 473,09±141,07 mg/dl ve ortalama HbA1c 12,04±2,42 olarak bulunmuştur. Bu süre içerisinde bir hasta kaybedilmiş olup mortalite oranı %0,5’tir (1/190). Sonuç: Hastaları ilk gören birinci basamak hekimlerinin DKA hakkındaki bilgilerini artırmak ve ağır DKA ataklarının en sık görüldüğü ve kaybedilen tek olgunun yer aldığı 0-5 yaş grubunda tedaviyi çok daha yavaş ve dikkatli bir biçimde sürdürmek morbidite ve mortaliteyi azaltacaktır.
Aim: Diabetic ketoacidosis (DKA) is a serious condition with the highest rates of morbidity and mortality in children with type 1 diabetes mellitus (T1DM). Hospitalization due to DKA constitutes about 2 to 8 percent of all-cause admissions. About 25% of children with newly diagnosed T1DM present with DKA. In this study, we aimed to evaluate sociodemographic and clinical characteristics of children admitted with DKA. Materials and Method: Records of 490 children admitted with T1DM between January 2003 and October 2008 were retrospectively reviewed and data on sociodemographic, clinical and laboratory characteristics of 163 children with the diagnosis of DKA was investigated in detail. Results: Of 490 children with T1DM, 163 (33.2%) had the diagnosis of DKA and total number of DKA episodes was 190. The recurrence rate was 14.2% and 85% (6 out of 7) of those with recurrent episodes were girls. The mean age was 11.02±4.57 years and DKA episodes were most frequently seen in 10-15 (39.3) age-group. DKA episodes peaked in the periods of January-February-March and September-October-November. Severe DKA was mostly seen in younger children (i.e., 0-5 age group) (54.5%). The mean duration of recovery from acidosis was 14.29±12.14 hours, the mean blood glucose level at baseline was 473.09±141.07 mg/dl and the mean initial HbA1c level was 12.04±2.42%. In this approximately six-year-period, only one patient was lost and the mortality rate was 0.5% (1 out of 190 episodes). Conclusion: Increasing the knowledge of primary care physicians who see the patients first on DKA and applying the DKA treatment protocol more slowly and cautiously in younger children (0-5 age group) will definitely lower the morbidity and mortality of DKA.
Aim: Diabetic ketoacidosis (DKA) is a serious condition with the highest rates of morbidity and mortality in children with type 1 diabetes mellitus (T1DM). Hospitalization due to DKA constitutes about 2 to 8 percent of all-cause admissions. About 25% of children with newly diagnosed T1DM present with DKA. In this study, we aimed to evaluate sociodemographic and clinical characteristics of children admitted with DKA. Materials and Method: Records of 490 children admitted with T1DM between January 2003 and October 2008 were retrospectively reviewed and data on sociodemographic, clinical and laboratory characteristics of 163 children with the diagnosis of DKA was investigated in detail. Results: Of 490 children with T1DM, 163 (33.2%) had the diagnosis of DKA and total number of DKA episodes was 190. The recurrence rate was 14.2% and 85% (6 out of 7) of those with recurrent episodes were girls. The mean age was 11.02±4.57 years and DKA episodes were most frequently seen in 10-15 (39.3) age-group. DKA episodes peaked in the periods of January-February-March and September-October-November. Severe DKA was mostly seen in younger children (i.e., 0-5 age group) (54.5%). The mean duration of recovery from acidosis was 14.29±12.14 hours, the mean blood glucose level at baseline was 473.09±141.07 mg/dl and the mean initial HbA1c level was 12.04±2.42%. In this approximately six-year-period, only one patient was lost and the mortality rate was 0.5% (1 out of 190 episodes). Conclusion: Increasing the knowledge of primary care physicians who see the patients first on DKA and applying the DKA treatment protocol more slowly and cautiously in younger children (0-5 age group) will definitely lower the morbidity and mortality of DKA.
Description
Keywords
Diabetes mellitus, Diyabetik ketoasidoz, Mortalite, Diabetic ketoacidosis, Mortality
Citation
Sağlam, H. vd. (2008). "Diyabetik ketoasidozla başvuran çocukların klinik ve laboratuvar özellikleri". Güncel Pediatri, 6(3), 94-98.