LA CONSULTA SEMANAL

ABRIL 2001

CONSULTA

Endocrinol Metab Clin North Am 2000 Dec;29(4):683-705, V Diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome. Delaney MF, Zisman A, Kettyle WM Endocrinology-Hypertension Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA. Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS) are life-threatening acute metabolic complications of diabetes mellitus. Although there are some important differences, the pathophysiology, the presenting clinical challenge, and the treatment of these metabolic derangements are similar. Each of these complications can be seen in type 1 or type 2 diabetes, although DKA is usually seen in patients with type 1 diabetes and HHNS in patients with type 2 disease. The clinical management of these syndromes involves careful evaluation and correction of the metabolic and volume status of the patient, identification and treatment of precipitating and comorbid conditions, a smooth transition to a long-term treatment regimen, and a plan to prevent recurrence. Publication Types:   Review   Review, tutorial Endocrinol Metab Clin North Am 2000 Dec;29(4):657-82 Diabetic ketoacidosis in children. White NH Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, Missouri, USA. [email protected] Diabetic ketoacidosis is a serious condition that warrants immediate and aggressive intervention. Even with appropriate intervention, DKA is associated with significant morbidity and possible mortality in diabetic patients in the pediatric age group. With appreciation of its severity, proper understanding of the pathophysiology, and careful attention to the details of management and close monitoring, most cases will have a satisfactory outcome. Because treatment is costly and because the risk for morbidity remains even under the best of circumstances, prevention of DKA must be a major goal in the treatment of type 1 diabetes mellitus. Involvement and close follow-up by a multidisciplinary team of health care professionals with experience in dealing with diabetes in children and adolescents is the best way to avoid DKA. Publication Types:   Review   Review, tutorial Am J Emerg Med 2000 Oct;18(6):658-60 Initial fluid management of diabetic ketoacidosis in children. Rutledge J, Couch R Department of Pediatrics, University of Alberta, Edmonton, Canada. The purpose of this study was to review the emergency department management of children presenting in diabetic ketoacidosis (DKA) to determine if current  recommendations for fluid therapy are practiced. A 5-year retrospective chart review was conducted of all pediatric patients admitted with DKA to the University of Alberta Hospital. Presenting clinical and laboratory data, the initial fluid therapy, and insulin dose were analyzed. The therapy was also compared between sites of initial presentation (primary, secondary, or tertiary hospital). A total of 49 cases of DKA in 37 patients were reviewed. There were no significant clinical or biochemical differences between patients presenting at the three levels of hospital. Forty-one cases (84%) were given a saline bolus and the mean fluid volume given by 1 hour was 18.3 mL/kg. In the first hour 82% of patients presenting at a primary or secondary centre and 67% of those at the tertiary centre received more than 10 mL/kg. This excessive fluid therapy was also evident after 4 hours. Fluid management of children in DKA is excessive and not in keeping with current recommendations. Education of emergency physicians is needed to reduce fluid therapy and the risk of neurologic complications. Crit Care Med 1999 Dec;27(12):2690-3 Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? Viallon A, Zeni F, Lafond P, Venet C, Tardy B, Page Y, Bertrand JC Emergency and Intensive Care Units, Hopital Bellevue, Centre Hospitalo-Universitaire, Saint-Etienne, France. OBJECTIVE: The use of bicarbonates in the treatment of severe diabetic ketoacidosis remains controversial, especially regarding the benefit/risk ratio. The aim of this study was to assess the efficacy of bicarbonate therapy during severe diabetic ketoacidosis (pH

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Hola, me llamo Marco y soy el fundador de InterMedicina.com donde comparto consejos sobre nutrición, dietética y vida sana. Espero que mis 13 años de experiencia le ayuden a alcanzar sus objetivos de salud.