Prevalencia de edema cerebral en pacientes con cetoacidosis diabética / Prevalence of cerebral edema among diabetic ketoacidosis patients

Introducción. El edema cerebral (EC) es la complicación más grave de la cetoacidosis diabética (CAD) en niños. La patogénesis del EC no se conoce con exactitud y su aparición ha sido relacionada con la terapia de rehidratación endovenosa en el tratamiento inicial.Objetivos. Estimar la prevalencia de EC en pacientes con CAD tratados en el Hospital General de Niños Pedro de Elizalde mediante rehidratación endovenosa y analizar potenciales factores de riesgo para el desarrollo de EC.Materiales y método. Estudio de diseño transversal para prevalencia y un análisis exploratorio para comparar las características clínicas y de laboratorio entre los pacientes con y sin EC. Se incluyeron pacientes de 1 a 18 años hospitalizados con diagnóstico de CAD desde el 1 de enero de 2005 hasta el 31 de diciembre de 2014.Resultados. Se analizaron 693 episodios de CAD en 561 historias clínicas. En 10 pacientes, se evidenció EC (el 1,44 %; intervalo de confianza del 95 %: 0,8-2,6). Los pacientes con EC presentaron mayor uremia (p < 0,001), menor presión de dióxido de carbono (p < 0,001) y menor natremia (p < 0,001) que aquellos pacientes sin EC.Conclusión. La prevalencia de EC en pacientes con CAD fue del 1,44 %, menor que la reportada en nuestro país (del 1,8 %). Los factores de riesgo al ingresar asociados a su desarrollo fueron la presencia de uremia elevada, hiponatremia e hipocapnia.

Introduction. Cerebral edema (CE) is the most severe complication of diabetic ketoacidosis (DKA) in children. There is no accurate knowledge of CE pathogenesis and its onset has been related to intravenous rehydration therapy during the initial treatment.Objectives. To estimate the prevalence of CE among DKA patients treated at Hospital General de Niños Pedro de Elizalde with intravenous rehydration and analyze potential risk factors for the development of CE.Materials and methods. Cross-sectional prevalence study and exploratory analysis to compare clinical and laboratory characteristics between patients with and without CE. Patients aged 1-18 years hospitalized with the diagnosis of DKA between January 1st, 2005 and December 31st, 2014 were included.Results. A total of 693 DKA events from 561 medical records were analyzed. Ten patients had evidence of CE (1.44 %; 95 % confidence interval: 0.8-2.6). Patients with CE had higher serum urea levels (p < 0.001), lower carbon dioxide pressure (p < 0.001), and lower serum sodium levels (p < 0.001) than those without CE.Conclusion. The prevalence of CE among DKA patients was 1.44 %, smaller than that reported in our country (1.8 %). The risk factors at admission associated with CE development were high serum urea levels, hyponatremia, and hypocapnia.

Daño renal agudo y cetoacidosis diabética en pacientes pediátricos: factores de riesgo / Acute kidney injury and diabetic ketoacidosis in pediatric patients: risk factors

El daño renal agudo es causa de morbilidad en niños diabéticos en países en vías de desarrollo, especialmente, en pacientes con cetoacidosis diabética. El objetivo de esta investigación fue identificar factores de riesgo para daño renal agudo en pacientes con cetoacidosis diabética. Se realizó un estudio de cohorte retrospectiva. Se incluyeron 50 pacientes diabéticos con cetoacidosis; el 54 % desarrollaron daño renal; en ellos, los niveles de glucosa y ácido úrico fueron mayores (541 mg/dl contra 407 mg/dl, p = 0,014, y 8,13 mg/dl contra 5,72 mg/dl, p = 0,015, respectivamente). El ácido úrico mayor de 6,5 mg/dl demostró un odds ratio de 6,910 (p = 0,027) para daño renal. En conclusión, la hiperuricemia fue un factor de riesgo para el desarrollo de daño renal agudo en estos pacientes. Son necesarios estudios prospectivos para determinar el papel del ácido úrico en la patogénesis del daño renal agudo en pacientes diabéticos.

Acute kidney injury is a cause of morbidity in children with diabetes in developing countries, especially in patients with diabetic ketoacidosis. The objective of this study was to identify the risk factors for acute kidney injury in patients with diabetic ketoacidosis. This was a retrospective cohort study. A total of 50 patients with diabetic ketoacidosis were included; 54 % developed kidney injury. These had higher glucose and uric acid levels (541 mg/dL vs. 407 mg/dL, p = 0.014 and 8.13 mg/dL vs. 5.72 mg/dL, p = 0.015, respectively). Uric acid levels above 6.5 mg/dL showed an odds ratio of 6.910 (p= 0.027) for kidney injury. To conclude, hyperuricemia was a risk factor for acute kidney injury in these patients. Prospective studies are required to determine the role of uric acid in the pathogenesis of acute kidney injury in patients with diabetes.

Profils épidémiologiques des acidocétoses diabètiques aux urgences

Introduction: l'acidocétose diabétique (ACD) est une complication métabolique grave du diabète. Son incidence est en augmentation ces dernières années, cependant sa mortalité reste faible. L'objectif de cette étude a été de décrire les caractéristiques épidémiologiques, cliniques, thérapeutiques et pronostiques des patients admis aux urgences pour ACD sévère ou modérée. Méthodes: il s'agissait d'une étude prospective, descriptive qui a inclus les ACD modérée ou sévère. Standardisation du protocole de prise en charge thérapeutique. Nous avons étudié les caractéristiques épidémiologiques, cliniques, thérapeutiques et pronostiques chez ces patients. Résultats: nous avons inclus 185 patients avec ACD sévère ou modérée. L'âge moyen a été de 38±18 ans; le sexe ratio=0,94. Diabète connue= 159 patients (85%) dont 116 étaient des diabétiques type 1. Les facteurs de décompensation les plus fréquents étaient l'arrêt du traitement chez 42% et l'infection chez 32%. La glycémie moyenne a été de 32,7±12mmol/L, pH =7,14±0,13, HCO-3 =7,2±3,56 mmol /L. La durée moyenne de l'insuline intraveineuse était de 17,3±16 heures. L'hypoglycémie a été observée chez 26 patients (14%), l'hypokaliémie chez 80 (43%). La mortalité au cours de l'hospitalisation a été de 2,1%. Conclusion: l'acidocétose diabétique survient chez les sujets jeunes traités par insulinothérapie. Le traitement est à base d'insuline par voie intraveineuse en plus de la correction du déficit hydrique. Les complications sont essentiellement l'hypokaliémie et l'hypoglycémie; et la mortalité reste faible

Mucormicosis Rinocerebral asociado a Cetoacidosis diabética / Rhinocerebral Mucormycosis associated to diabetic ketoacidosis

Mucormycosis is an infrequent fungal infection This infection is difficult to diagnose and treat and have a high morbility and mortality and affects immunocompromised patients, especially those patients with decompensated diabetes mellitus. We report the case of a 60 years old diabetic patient with poor metabolic control who was admitted for diabetic ketoacidosis and days later present right periorbital swelling and pain, is diagnosed of mucomycosis and is successfully treated with amphoterin B and surgery.

Perfil clínico de niños con cetoacidosis diabética en una unidad de paciente crítico / Clinical profile of children with diabetic ketoacidosis in a critical care unit

INTRODUCCIÓN: La cetoacidosis (CAD) es la principal causa de morbimortalidad en niños con diabetes mellitus tipo 1 (DM1) debido a las alteraciones bioquímicas asociadas, siendo el más temido el edema cerebral, con altas tasas de mortalidad y secuelas neurológicas a largo plazo. OBJETIVO: caracterizar el perfil clínico y las complicaciones de pacientes con CAD ingresados en una unidad de paciente crítico pediátrico. PACIENTES Y MÉTODO: Revisión retrospectiva de pacientes con CAD atendidos en el Hospital Clínico de la Pontificia Universidad Católica de Chile (UPCPUC) entre los años 2000 y 2015. Se evaluaron características demográficas, manifestaciones clínicas, alteraciones bioquímicas, tratamiento, complicaciones y pronóstico. Se compararon pacientes con debut de DM1 versus diabéticos conocidos, analizándose variables según distribución. RESULTADOS: Se identificaron 46 episodios de CAD. El 67% de éstos correspondió a un debut de DM1. El 66% de los diabéticos conocidos ingresaron por mala adherencia al tratamiento. Los principales síntomas de presentación fueron: 63% polidipsia, 56% poliuria, 48% vómitos, 39% pérdida de peso y 35% dolor abdominal, con medias de Glicemia 522 mg/dL, pH 7,17 y osmolaridad plasmática 305 mOsm/L. El 89% recibió insulina en infusión. El 37% presentó hipokalemia. No se registraron episodios de edema cerebral ni muertes. CONCLUSIONES: La mayoría de los ingresos por CAD correspondió a debut de DM1. En el grupo de diabéticos conocidos, la mala adherencia al tratamiento fue la principal causa de descompensación. No se presentaron complicaciones graves ni muertes asociadas al manejo de la CAD durante el período estudiado. El diagnóstico precoz y el tratamiento adecuado y estandarizado pudieran contribuir a reducir la morbilidad y mortalidad en niños con CAD.

INTRODUCTION: Diabetic ketoacidosis (DKA) is the main cause of morbidity and mortality in children with type 1 diabetes mellitus (T1DM) due to clinical and biochemical alterations associated, cerebral edema as one of the most critical because of the high mortality rates and long-term neurological se quelae. OBJECTIVE: To analyze the clinical characteristics and complications of patients with DKA ad mitted to a pediatric intensive care unit. PATIENTS AND METHODS: Retrospective study of DKA patients treated at the Hospital Clínico, Pontificia Universidad Católica de Chile (UPCPUC) between 2000 and 2015. Demographic characteristics, clinical manifestations, biochemical alterations, treatment, complications, and prognosis were assessed. Patients with T1DM onset were compared with those patients already diagnosed with diabetes, analyzing variables according to distribution. RESULTS: 46 DKA events were identified, 67% of them were the first episode of DKA. 66% of patients already diagnosed with diabetes were admitted due to poor adherence to treatment. The main symptoms described were: 63% polydipsia, 56% polyuria, 48% vomiting, 39% weight loss and 35% abdominal pain, and mean blood sugar levels of 522 mg/dL, pH 7.17, and plasma osmolality of 305 mOsm/L. 89% of patients received insulin infusion, and 37% presented hypokalemia. No episodes of cerebral edema or deaths were registered. CONCLUSIONS: Most of the DKA admissions were due to T1DM onset. In the group of patients already diagnosed with diabetes, the poor adherence to treatment was the main cause of decompensation. There were no serious complications or deaths associated with DKA management during the studied period. Early diagnosis and proper and standardized treatment contributed to reducing morbidity and mortality in children with DKA.

Asociación entre cetoacidosis diabética y acromegalia / Association between diabetic ketoacidosis and acromegaly

La diabetes mellitus ocurre en cerca del 10% de los pacientes con acromegalia y es secundaria a la insulino resistencia causada por altos niveles de hormona de crecimiento. La cetoacidosis diabética ha sido descripta como una rara complicación de la acromegalia, resultado de una relativa deficiencia de insulina causada por exceso de hormona de crecimiento. Describimos el caso de un hombre de 38 años de edad que se presentó en el servicio de emergencias con historia de polifagia, polidispsia y poliuria con pérdida de peso de 6 semanas de evolución. Agregó en las últimas 48 horas náuseas, vómitos y dolor abdominal. A su ingreso, la glucosa plasmática fue 880 mg/dl, osmolaridad plasmática 368 mOsm/l, pH arterial 7.06 y bicarbonato plasmático 8.6 mEq/l. No tenía antecedentes personales ni familiares de diabetes. No se encontraron causas precipitantes de cetoacidosis. En el examen clínico presentaba características compatibles con acromegalia. La resonancia magnética nuclear mostró un macroadenoma pituitario y los dosajes de hormona de crecimiento fueron elevados. Luego de la resección del tumor, los niveles de glucosa plasmáticos resultaron normales. Este caso mostró la rara asociación de acromegalia con cetoacidosis diabética. La cirugía fue la modalidad definitiva de tratamiento.

Diabetes mellitus occurs in nearly 10% of patients with acromegaly and is secondary to insulin resistance caused by high levels of growth hormone. Diabetes ketoacidosis has been described as a rare complication of acromegaly, resulting from a relative insulin deficiency caused by growth hormone excess. We described the case of a 38 year-old man who presented to the emergency room with a 6-week history of polydipsia, polyuria, polyphagia and weight loss. He also had nausea, vomiting and abdominal pain from two days before admission. His plasma glucose level was 880 mg/dl, plasma osmolarity 368 mOsm/l, arterial pH 7.06 and serum bicarbonate 8.6 mEq/l. At the clinical examination, he had features of acromegaly. Magnetic resonance imaging showed a pituitary macro adenoma and growth hormone dosages were abnormally high. After tumor removal, plasma glucose levels became normal. This case shows the rare association between diabetic ketoacidosis and acromegaly. Surgery, in this case, was the definite modality of treatment.

The management of diabetic ketoacidosis at a rural regional hospital in KwaZulu-Natal

Background: Diabetic ketoacidosis (DKA) is a biochemical triad of hyperglycaemia, ketoacidosis and ketonaemia and one of the potentially life-threatening acute metabolic complications of diabetes mellitus. This study aimed at describing the clinical profile of patients presenting with DKA to a busy rural regional hospital in KwaZulu-Natal. Methods: A retrospective review of clinical notes of patients presenting with DKA to the Emergency Department was performed over a 10-month period. Data included patients' demographic profile, clinical presentation, precipitating factors, comorbidities, biochemical profile, length of hospital stay and outcome.Results: One hundred and five black South African patients above the age of 12 years were included in the study. Sixty-four (60.95%) patients had type 1 diabetes mellitus (T1DM) and 41 (39.05%) patients had type 2 diabetes mellitus (T2DM). Patients with T2DM were significantly older than those with T1DM (52.1 ± 12.4 years vs. 24.4 ± 9.5 years, p < 0.0001). The acute precipitant was identified in 68 (64.76%) cases with the commonest precipitant in T1DM patients being poor adherence to treatment, whereas in T2DM, the most common precipitant was infection. Nausea and vomiting were the most common presenting symptoms with the majority of patients presenting with non-specific symptoms. Fifty-seven (54.29%) cases had pre-existing comorbidities, with higher prevalence in T2DM than T1DM patients. Glycated haemoglobin was severely elevated in the majority of patients. Patients remained hospitalised for an average of 8.9 ± 7.5 days. The mortality rate was 17.14%, and 12 of the 18 deaths occurred in patients with T2DM.Conclusion: The prevalence of DKA was higher in patients with T1DM and those with pre-existing comorbidities. The mortality rate remains alarmingly high in older patients with T2DM

Cetoacidosis diabética euglucémica secundaria al uso de Dapagliflozina / Euglycemic diabetic ketoacidosis secondary to the use of Dapagliflozin

Los inhibidores del cotransportador sodio-glucosa tipo 2 son un grupo de fármacos que se utilizan en tratamiento de la diabetes tipo 2. Un efecto adverso que pueden producir es la cetoacidosis diabética euglucémica, una entidad clínica que se debe conocer para realizar el adecuado diagnóstico y tratamiento, suspendiendo la administración de dichos fármacos.

Inhibitors of sodium-glucose cotransporter type 2 are a group of drugs used in treatment of type 2 diabetes. Euglycemic diabetic ketoacidosis is an adverse effect that may occur and a clinical entity that should be known for proper diagnosis and treatment, suspending the administration of this medication.

Cetosis normoglicémica en adolescente con diabetes tipo 1 recibiendo insulina y dapaglifozina: Reporte de un caso / Euglycemic ketosis in an adolescent with type 1 diabetes on insulin and dapaglifozin: Case report

Dapaglifozina, un inhibidor del cotransportador de sodio-glucosa 2 (I-SGLT2) induce glucosuria y reduce la glicemia en adultos con diabetes tipo 2. Objetivo: Presentar una cetosis diabética “normoglicémica” en una adolescente con diabetes tipo 1 (DM1) que recibía dapaglifozina y alertar sobre el riesgo del uso I-SGLT2 que parece promisorio, pero no está aprobado en niños ni en DM1. Caso clínico: Paciente de 17 años sin cetosis durante 9 años con DM1, inició dapaglifozina 10 mg/día para reducir la insulina y el peso. Durante 11 meses de tratamiento tuvo cetonas capilares indetectables, redujo el índice de masa corporal 23,9 a 21,1 kg/m², la insulina basal 40 a 17 U, la hemoglobina glicosilada 8,3 a 7,5%, la glicemia capilar 175 a 161 mg/dl y la variabilidad de la glucosa (desvío estándar 85 a 77). Inesperadamente aparecieron náuseas y vómitos. La paciente portaba bomba de insulina con monitorización continua de glucosa, bien calibrada (glucosas intersticiales concordantes con glicemias), que mostraba glucosa estable bajo 200 mg/dl. Recibió insulina pero los vómitos persistieron; en tres horas, aparecieron deshidratación y desmayos, con cetonas 4,6 nmol/l y glicemia 224 mg/dl. Recibió suero fisiológico, ondansetrón, carbohidratos y varias dosis de insulina con pronta recuperación del estado general e hidratación, sin embargo, la cetosis continuó durante 24 horas. Cabe destacar que la bomba estaba funcionando bien y no se cambió la cánula. Al superar la cetosis, continuó con la misma cánula con buen control metabólico. Conclusión: Es importante sospechar la cetosis diabética normoglicémica por ser de riesgo vital.

Dapagliflozin, an insulin-independent sodium-glucose cotransporter 2 inhibitor (SGLT2-I) induces glycosuria and reduces hyperglycemia in adults with type 2 diabetes. Objective: To present an “euglycemic” diabetic ketosis in an adolescent with type 1 diabetes (T1D) receiving dapagliflozin, to alert about the risk of a drug not approved in children nor in T1D. Case report: A 17 years old adolescent with T1D during 9 years, was started on dapagliflozin 10 mg / day to reduce insulin dose and weight. During 11 months on treatment, capillaries ketones were undetectable and she exhibited a reduction in body mass index 23.9 to 21.1 kg/m2, basal insulin 40 to 17 U, glycated hemoglobin 8.3 to 7.5%, capillary glucose 175 to 161 mg/dl and glucose variability (standard deviation) 85 to 77. Suddenly nausea and vomits appeared. The patient was on an insulin pump and well calibrated continuous glucose monitoring, showing stable glucose levels under 200 mg/dl, and an insulin bolus was delivered. Vomiting without hyperglycemia persisted; three hours later, she was severely dehydrated and fainting, with ketones 4.6 nmol/l and glucose 224 mg/dl. She received IV saline fluids, ondansetron, carbohydrates and several insulin boluses. Hydration and general condition improved soon, however despite several insulin doses, ketosis continued for 24 hours. It is remarkable that the pump was working well and the cannula was not changed. After the ketosis was resolved, she continued using the same cannula with good metabolic control. Conclusion: Euglycemic ketosis is a life-threatening condition that must be suspected.

Diabetic ketoacidosis in a pediatric intensive care unit / Cetoacidose diabética em uma unidade de terapia intensiva pediátrica

Abstract Objective: To describe the characteristics of children aged 0-14 years diagnosed with diabetic ketoacidosis and compare the following outcomes between children with prior diagnosis of type 1 diabetes mellitus and children without prior diagnosis of type 1 diabetes mellitus length of hospital stay, severity on admission, insulin dosage, time of continuous insulin use, volume of fluids infused during treatment, and complications. Methods: A retrospective descriptive study with review of medical records of patients admitted to the pediatric intensive care unit of a referral hospital from June 2013 to July 2015. The following data regarding 52 admissions were analyzed: age, sex, weight, body surface area, signs, symptoms and severity on admission, blood gas, blood glucose, glycated hemoglobin, serum osmolarity, and index of mortality. The insulin dosage, time of continuous insulin use, volume administered in the expansion phase and in the first 24 h, length of stay, and complications such as electrolyte disturbances, hypoglycemia, cerebral edema, and death were compared between the two groups. Results: Patients without a previous diagnosis of DM1 were younger at admission, with mean age of 8.4 years (p < 0.01), reported more nausea or vomiting, polydipsia and polyuria, and showed more weight loss (p < 0.01). This study also observed a higher prevalence of hypokalemia (p < 0.01) and longer hospital stay in this group. Conclusions: No differences in severity between groups were observed. The study showed that children without prior diagnosis of type 1 diabetes mellitus were younger at admission, had more hypokalemia during the course of treatment, and had greater length of hospital stay.

Resumo Objetivo: Descrever as características de pacientes até 14 anos admitidos com diagnóstico de cetoacidose diabética e comparar desfechos entre os pacientes com diabete melito tipo 1 prévio e aqueles sem diabete melito tipo 1 prévio: tempo de internação, gravidade na admissão, dose de insulina usada, tempo de insulinização contínua, volume de líquido infundido durante o tratamento e complicações. Métodos: Estudo descritivo retrospectivo com revisão de prontuários de pacientes internados na UTI pediátrica de um hospital de referência de junho de 2013 a julho de 2015. Analisamos os seguintes dados referentes a 52 internações: idade, sexo, peso, superfície corporal, sinais, sintomas, gravidade na admissão, gasometrias, glicemia, hemoglobina glicada, osmolaridade sérica e índice de mortalidade. As crianças com diabete já diagnosticado foram comparadas com aquelas sem diagnóstico prévio quanto à dose de insulina, tempo de insulinização contínua, volume infundido na fase de expansão e nas primeiras 24 horas, tempo de internação e complicações como distúrbios hidroeletrolíticos, hipoglicemia, edema cerebral e morte. Resultados: Os pacientes sem diagnóstico prévio de DM I eram mais jovens no momento da admissão, com média de 8,4 anos (p < 0,01). Relataram mais sintomas como vômitos, polidipsia e poliúria e apresentaram mais perda de peso (p < 0,01). Observamos maior prevalência de hipocalemia (p < 0,01) e maior tempo de internação no grupo acima citado. Conclusões: Não observamos diferenças quanto à gravidade entre os grupos. Pacientes diabéticos prévios eram mais jovens na admissão, apresentaram mais hipocalemia durante o tratamento e permaneceram mais tempo internados.

Cetoacidosis diabética euglicémica asociada a inhibidor de cotransportador de sodio glucosa Tipo 2 en paciente con diabetes Mellitus Tipo 1 / Diabetic ketoacidosis with mild hyperglycemia associated with the use of canagliflozin. report of one case with type 1 diabetes

Diabetic ketoacidosis with mild hyperglycemia is a major complication of sodium-glucose cotransporter 2 inhibitors. Although its use is not approved for patients with type 1 diabetes mellitus, the drug is often prescribed with the hope of optimizing metabolic control. We report a 20 years old female with hypothyroidism and type 1 diabetes consulting for vomiting and abdominal pain. The patient had used canagliflozin during the two previous months. Laboratory showed a blood glucose of 200 mg/dl, a severe metabolic acidosis (pH 7.1) and ketonemia. The patient was successfully treated in the intensive care unit.

Diagnóstico diferencial de cetoacidosis hiperglicémica: Intoxicación por plaguicidas. Caso clínico / Differential diagnosis from hyperglycemic ketoacidosis: Pesticide poisoning. Clinical case

La cetoacidosis diabética en niños puede ser una causa de morbilidad grave y mortalidad, especialmente si no se reconoce en el momento del primer diagnóstico. Sin embargo, existen otras patologías que pueden aparentar una alteración metabólica de este tipo y pasarse por alto si no se tiene sospecha clínica. A continuación, se describe un caso clínico que presenta cetoacidosis hiperglicémica debido al contacto con organofosforado, en el cual fue necesario el uso de insulina en infusión continua para el control del trastorno metabólico, sin repercusiones después del alta.

Diabetic ketoacidosis in children causes serious morbidity and mortality, especially if it is not recognized on time in the initial diagnosis. However, there are other diseases that can appear to be a metabolic disorder of this kind and be ignored if it is not suspected. We present a clinical case with hyperglycemic ketoacidosis due to the contact with organophosphate; we had to use a continuous infusion of insulin to control the metabolic disorder without repercussions after the girl came home.

Application of Postmortem Biochemistry in Forensic Diagnosis of Diabetic Ketoacidosis / 法医学杂志

Diabetic ketoacidosis is a serious complication results from the high blood levels of glucose and ketone in diabetes mellitus patients that cause metabolic overbalance. An analysis of postmortem biochemical indexes is needed in such cases without specific signs of the routine forensic medicine examination. Postmortem biochemistry is a kind of examinations that collecting the body fluids of the corpses to determine the metabolic state of their life time to estimate the cause of death. This paper reviews the basic features and signs of the forensic medicine examination in the dead cases of diabetic ketoacidosis, and emphatically analyzes the postmortem biochemical indexes of diabetic ketoacidosis, and summarizes new ideas of forensic medicine diagnosis in diabetic ketoacidosis death.

Característica clínico-epidemiológica de los pacientes pediátricos con cetoacidosis diabética / Clinical and epidemiological characteristics of pediatric patients with diabetic ketoacidosis

Antecedentes: La Cetoacidosis diabética (CAD) es una complicación de la Diabetes Mellitus, cuya importancia va cada vez en aumento. Es el trastorno metabólico que causa más ingresos a las unidades de cuidado inten- sivo pediátrico con una tasa de hospitalización que se ha mantenido alrededor de 10 por 100.000 niños/año. Objetivo: Describir las características clínico-epidemiológicas de la cetoacidosis diabética en los pacientes meno- res de 18 años. Pacientes y métodos: Se reali- zó un estudio descriptivo. La información fue recopilada mediante encuesta sobre caracte- rísticas socio-demográficas, epidemiológicas y diagnóstica en niños con CAD que fueron ingresados en la emergencia de pediatría del Hospital Nacional Dr. Mario Catarino Rivas (HNMCR), durante el período de agosto 2013 a agosto del 2015 (n=30). Resultados: Se en- contró 18 (60%) mujeres y 12 (40%) varones con CAD. El promedio de edad de los pacientes diagnosticados con CAD fue de 12 años, con una mediana de 13 años. El 50% de los pacien- tes con CAD eran debutantes y el 20% tenían 2 años de diagnóstico. Las infecciones de tracto urinario estuvieron presentes en el 40% de los casos. El promedio de glicemia sérica en los pacientes con CAD fue de 500 mg/dl. El edema cerebral fue la principal complicación encontrada en un 33.3% de los casos. Fallecie- ron el 7% de los pacientes con CAD. Conclusio- nes: La CAD es frecuente en mujeres adoles- centes y es desencadenado principalmente por infecciones del tracto urinario...(AU)

Acidose tubular renal tipo IV no pronto atendimento / Renal tubular acidosis type IV in emergency medical services

No Hospital de Base de São José do Rio Preto, uma paciente com diabetes melito tipo 2, apresentando quadro de acidose metabólica, foi tratada na emergência da clínica médica. Foi seguido inicialmente protocolo de cetoacidose diabética. Após um dia sem melhora clínica, com a hipótese diagnóstica de acidose tubular renal tipo IV, confirmada pela acidose metabólica hipercalêmica e hiperclorêmica, foi optado por introduzir fludrocortisona no tratamento. Devido à melhora clínica e laboratorial fechou-se o diagnóstico e a paciente encontra-se em acompanhamento no ambulatório.

At the Hospital de Base hospital in São José do Rio Preto, a type II diabetic patient presenting metabolic acidosis was treated at the internal medicine ER. Initially the diabetic ketoacidosis treatment protocol was followed. Due to no improvement after one day of treatment, the diagnostic hypothesis of renal tubular acidosis type IV was confirmed by the hyperkalemic and hyperchloremic metabolic acidosis. We treated the patient with fludrocortisone. Due to clinical recovery and improvement of laboratory results, the patient was discharged and is now an outpatient in our institution.