Diyabetik ketoasidozla başvuran çocuk olguların değerlendirilmesi
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Date
2013
Authors
Koyuncu, Ekrem
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Diyabetik ketoasidoz (DKA) insülin eksikliğinin ciddi bir sonucu olup tip 1 diabetes mellituslu (DM) çocuklarda önemli ölçüde mortalite ve morbiditeye neden olan bir durumdur. DKA vakalarının geriye dönük olarak değerlendirilmesi; tedaviye yanıtın değerlendirilebilmesi, komplikasyonların azaltılabilmesi, yeni tedavi yaklaşımlarının ortaya konulabilmesi açısından önem taşımaktadır. Uludağ Üniversitesi Tıp Fakültesi Çocuk Endokrinoloji Bilim Dalı’nda 01.01.1997-15.11.2012 tarihleri arasında DKA tanısıyla tedavi gören 379 hastaya ait toplam 412 DKA atağı retrospektif olarak incelendi. Başvurudan önce tip 1 DM tanısı olmayanlar yeni tanı tip 1 DM; başvurudan önce tip 1 DM tanısı olanlar ise eski tanı tip 1 DM olarak adlandırıldı. Çalışmamızda, yeni tanı tip 1 DM’li hasta sayısı 296 olup, bunların 147’si (%49,7) erkek, 149’u (%50,3) kızdır. Eski tanı tip 1 DM’li 83 hastaya ait 116 başvuru saptanmıştır. Bu hastaların 54’ü (%65,1) kız, 29’u (%34,9) erkektir. Aynı grupta saptanan 116 atağın 79’u (%68,1) kız, 37’si (%31,9) erkektir. Yeni tanı tip 1 DM grubunda, medyan başvuru yaşı 8,7 yıl iken, eski tanı tip 1 DM grubunda medyan başvuru yaşı 12,1 yıl olarak bulundu. Yeni tanı tip 1 DM grubunda en fazla başvuru sırasıyla Mart, Ocak ve Şubat aylarında olurken, en az başvuru Aralık ayında olmuştur. Eski tanı tip 1 DM grubunda ise en fazla başvuru sırasıyla Ekim ve Nisan aylarında olurken, en az başvuru Aralık ayında olmuştur. Eski tanı tip 1 DM grubunda en sık DKA nedenleri; insülin dozunun atlanması (%58,6) ve diyete uyamama (%56) olarak bulundu. Yeni tanı tip 1 DM grubunda medyan semptom süresi 14 gün olup, en sık görülen semptomlar, sırasıyla poliüri, polidipsi ve kilo kaybı iken; eski tanı tip 1 DM grubunda medyan semptom süresi 2 gün olup en sık görülen semptomlar sırasıyla kusma, poliüri ve polidipsidir. Yeni tanı tip 1 DM grubunda ağır dehidratasyon oranı, eski tanı tip 1 DM grubuna göre daha fazladır. İki grup arasında ketoasidoz dereceleri iii açısından istatistiksel olarak anlamlı bir farklılık saptanmamıştır. Yeni tanı tip 1 DM grubunda medyan ketoasidozdan çıkış süresi 18 saat, eski tanı tip 1 DM grubunda ise 13 saattir. Her iki grupta da tedavi ve izlem sırasında en sık görülen komplikasyonlar sırasıyla hipokalemi ve hipofosfatemidir. Toplam 15 yıllık sürede, yeni tanı tip 1 DM grubunda 2 hasta beyin ödemi ve ilişkili komplikasyonlar sonucu kaybedilmiştir. Çalışmamızda; yeni tanı ve eski tanı tip 1 DM gruplarında, başvuru özellikleri, laboratuar değerleri, izlem bulguları açısından erkekler ve kızlar arasında istatistiksel olarak anlamlı farklılık saptanmamıştır. Yeni tanı ve eski tanı tip 1 DM gruplarında, en fazla DKA atağı başvurusu 10-15 yaş grubunda gerçekleşmiştir. Yeni tanı tip 1 DM grubunda başvuru sırasındaki glukoz, venöz pH, venöz HCO3 değerleri, diğer yaş gruplarıyla karşılaştırıldığında; ketoasidozun 0-5 yaş grubunda, diğer yaş gruplarına göre daha şiddetli olduğu belirlenmiştir. Çalışmamızın ortaya koyduğu verilerin, DKA’lı olguların başvuru, tedavi ve izlem sürecinde göz önünde bulundurulmasının faydalı olacağı düşünülmüştür.
Diabetic ketoacidosis (DKA) is a severe result of insulin deficiency and is a condition that significantly causes morbidity and mortality in children with type 1 diabetes mellitus (DM). Retrospective analysis of DKA cases is important in terms of evaluation of response to treatment, reduction of complications, and to introduce new approaches of treatment. At the University of Uludağ, Faculty of Medicine, Division of Pediatric Endocrinology between the dates 01.01.1997 and 15.11.2012, a total of 412 DKA attacks belonging to 379 patients who were treated with the diagnosis of DKA were studied retrospectively. Those who were not diagnosed as type 1 DM prior to admission have been called as new diagnosis type 1 DM; those who were diagnosed as type 1 DM prior to admission have been named as old diagnosis type 1 DM. In our study, the number of new diagnosis type 1 DM patients was 296 and of these, 147 (49,7%) were boys and 149 (50,3%) were girls. A total of 116 attacks belonging to 83 patients with old diagnosis type 1 DM were determined. Of the patients with old diagnosis type 1 DM, 54 (65.1%) were girls and 29 (34.9%) were boys. Of 116 attacks detected in the same group, 79 (68.1%) were from girls and 37 (31.9%) were from the boys. It has been found that the median age at admission was 8,7 years in the group of new diagnosis type 1 DM, whereas the median age at admission was 12,1 years in the group of old diagnosis type 1 DM. The highest numbers of consult in the new diagnosis type 1 DM group happened in the months of March, January and February, respectively; whereas the least in the month of December. On the other hand, he highest numbers of consult in the old diagnosis type 1 DM group happened in the months of October and April, respectively; whereas the least in the month of December. It was studied out that the most frequent causes of DKA in the old diagnosis type 1 DM group were skip of the insulin dose (58.6%) and failure to comply with the diet (56%). The median symptom duration in the new diagnosis type 1 DM group was 14 days and the most frequent symptoms were polyuria, polydipsia and weight loss, respectively; while the median symptom duration in the old diagnosis type 1 DM group was 2 days and the most frequent symptoms were vomiting, polyuria and polydipsia, respectively. Severe dehydration rate of the new diagnosis type 1 DM group was higher in comparison with the old diagnosis type 1 DM group. No statistically significant difference has been determined between the two groups in terms of degrees of ketoacidosis. The median duration to recover from ketoacidosis was 18 hours in the new diagnosis type 1 DM group, whereas it was 13 hours in the old diagnosis type 1 DM group. In both groups, the most common complications observed during the treatment and follow-up were hypokalemia and hypophosphatemia, respectively. In 15-year-period, 2 patients in the new diagnosis type 1 DM group died as a result of cerebral edema and complications related to it. In our study; in the groups of new and old diagnosis type 1 DM, no statistically significant difference, between boys and girls, has been determined in terms of application characteristics, laboratory values and follow-up findings. In the new and old diagnosis type 1 DM groups, the most common DKA attack application has occurred in the age group of 10 years to 15 years. In the new diagnosis type 1 DM group, when glucose, venous pH, venous HCO3 values were compared it was found that the 0-5 year age group indicated more severe ketoacidosis than other age groups. Taking into consideration of the data revealed by this study is intended to be useful in the admission, treatment and follow-up process of the cases with DKA.
Diabetic ketoacidosis (DKA) is a severe result of insulin deficiency and is a condition that significantly causes morbidity and mortality in children with type 1 diabetes mellitus (DM). Retrospective analysis of DKA cases is important in terms of evaluation of response to treatment, reduction of complications, and to introduce new approaches of treatment. At the University of Uludağ, Faculty of Medicine, Division of Pediatric Endocrinology between the dates 01.01.1997 and 15.11.2012, a total of 412 DKA attacks belonging to 379 patients who were treated with the diagnosis of DKA were studied retrospectively. Those who were not diagnosed as type 1 DM prior to admission have been called as new diagnosis type 1 DM; those who were diagnosed as type 1 DM prior to admission have been named as old diagnosis type 1 DM. In our study, the number of new diagnosis type 1 DM patients was 296 and of these, 147 (49,7%) were boys and 149 (50,3%) were girls. A total of 116 attacks belonging to 83 patients with old diagnosis type 1 DM were determined. Of the patients with old diagnosis type 1 DM, 54 (65.1%) were girls and 29 (34.9%) were boys. Of 116 attacks detected in the same group, 79 (68.1%) were from girls and 37 (31.9%) were from the boys. It has been found that the median age at admission was 8,7 years in the group of new diagnosis type 1 DM, whereas the median age at admission was 12,1 years in the group of old diagnosis type 1 DM. The highest numbers of consult in the new diagnosis type 1 DM group happened in the months of March, January and February, respectively; whereas the least in the month of December. On the other hand, he highest numbers of consult in the old diagnosis type 1 DM group happened in the months of October and April, respectively; whereas the least in the month of December. It was studied out that the most frequent causes of DKA in the old diagnosis type 1 DM group were skip of the insulin dose (58.6%) and failure to comply with the diet (56%). The median symptom duration in the new diagnosis type 1 DM group was 14 days and the most frequent symptoms were polyuria, polydipsia and weight loss, respectively; while the median symptom duration in the old diagnosis type 1 DM group was 2 days and the most frequent symptoms were vomiting, polyuria and polydipsia, respectively. Severe dehydration rate of the new diagnosis type 1 DM group was higher in comparison with the old diagnosis type 1 DM group. No statistically significant difference has been determined between the two groups in terms of degrees of ketoacidosis. The median duration to recover from ketoacidosis was 18 hours in the new diagnosis type 1 DM group, whereas it was 13 hours in the old diagnosis type 1 DM group. In both groups, the most common complications observed during the treatment and follow-up were hypokalemia and hypophosphatemia, respectively. In 15-year-period, 2 patients in the new diagnosis type 1 DM group died as a result of cerebral edema and complications related to it. In our study; in the groups of new and old diagnosis type 1 DM, no statistically significant difference, between boys and girls, has been determined in terms of application characteristics, laboratory values and follow-up findings. In the new and old diagnosis type 1 DM groups, the most common DKA attack application has occurred in the age group of 10 years to 15 years. In the new diagnosis type 1 DM group, when glucose, venous pH, venous HCO3 values were compared it was found that the 0-5 year age group indicated more severe ketoacidosis than other age groups. Taking into consideration of the data revealed by this study is intended to be useful in the admission, treatment and follow-up process of the cases with DKA.
Description
Keywords
Tip 1 diabetes mellitus, Diyabetik ketoasidoz, Çocuk, Type 1 diabetes mellitus, Diabetic ketoacidosis, Child
Citation
Koyuncu, E. (2013). Diyabetik ketoasidozla başvuran çocuk olguların değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.