| Abstract | Cilj istraživanja: Prikazati klinička obilježja i laboratorijske parametre pri prijemu te moguće komplikacije bolesti u djece koja su pod dijagnozom dijabetičke ketoacidoze zahtjevala intenzivno liječenje.
Materijali i metode: U istraživanje su uključeni ispitanici u dobi od 0 do 18 godina koji su zbog dijabetičke ketoacidoze liječeni u Zavodu za intenzivnu pedijatriju Klinike za dječje bolesti KBC Split u razdoblju od 1. siječnja 2013. do 31. prosinca 2017. Retrospektivno je analizirana medicinska dokumentacija. Ovisno o prethodno postavljenoj dijagnozi šećerne bolesti tip 1, ispitanici su podijeljeni u skupinu novo (NDM1) i ranije (RDM1) dijagnosticiranih bolesnika.
Rezultati: U istraživanje je uključeno 43 djece, 11 (25,6%) RDM1 i 32 (74,4%) NDM1 ispitanika. Prosječna dob RDM1 je bila 13,6±2,6 godina, a NDM1 7,7±4,1 godina (p<0,001). Pri prijemu je 90,7% svih ispitanika bilo klinički procijenjeno kao dehidrirano. Od ostalih obilježja, RDM1 ispitanici su najčešće navodili povraćanje, a NDM1 polidipsiju. Od ukupnog broja liječenih, poremećaj svijesti pri prijemu je imalo 47% (20/43) ispitanika, od čega je većina (17/20) bila somnolentna, a bez svijesti je zaprimljeno jedno dijete. NDM1 djeca su učestalije imala poremećaj svijesti, no razlika nije statistički značajna. Učestalost moždanog edema je bila 4,7% (2/43) te je jedno dijete preminulo. Oboje su pripadali NDM1 skupini.
Zaključak: U skupini NDM1 češće razvijaju kliničku sliku DKA koja zahtijeva liječenje u Jedinicama intenzivnog liječenja, te su mlađe životne dobi. U RDM1 se DKA javlja češće u dobi puberteta. NDM1 skupina se češće prezentira polidipsijom, poliurijom i nikturijom, dok se RDM1 skupina češće prezentira povraćanjem, mučninom i abdominalnom boli. Češće poremećaje svijesti imaju djeca koja pripadaju NDM1 skupini. U našem istraživanju dvoje djece je razvilo moždani edem. Kako bi učestalost djece s DKA bila što manja, važna je stalna edukacija i reedukacija oboljelih od dijabetesa te njihovih obitelji, kao i zdravstvenih radnika. Važno je i kontinuirano provođenje javnozdravstvenih programa s ciljem edukacije stanovništva kako bi rano prepoznali simptome i znakove DM1. |
| Abstract (english) | OBJECTIVES: To present clinical characteristics and laboratory parameters of children with diabetic ketoacidosis (DKA) requiring intensive care treatment at the time of admission and with possible complications.
MATERIAL AND METHODS: The study included subjects aged 0 to 18 who were treated for DKA in the Pediatric Intensive Care Unit of the University Hospital Split during the period from January 1st 2013. until December 31st 2017. Medical records were retrospectively analyzed. Weather diabetes mellitus type 1 (DM1) was previously diagnosed or not, the patients were divided into a group of children with newly diagnosed (NDM1) or with previously diagnosed DM1 (RDM1).
RESULTS: The study included 43 children, 11 (25.6%) with RDM1 and 32 (74.4%) with NDM1. The mean age of children with RDM1 was 13.6±2.6 years and with NDM1 was 7.7±4.1 years (p<0.001). At admition, 90.7% of all subjects were clinically evaluated as dehydrated. Children with RDM1 most frequently reported vomiting and children with NDM1 polydipsia. Out of all treated patients, 47% (20/43) had decreased consciousness level, most of them (17/20) were somnolent, and one child was unconscious. Children with NDM1 more frequently had decreased consciousness level, but without statistically significant difference. The cerebral edema was noted in 4.7% (2/43) patients, and one of them died. Both of them were in NDM1 group.
CONCLUSION: Children with NDM1 more often develop DKA requiring treatment in intensive care units and are younger. In children with RDM1, DKA appears more frequently during puberty. Children with NDM1 more frequently present with polydipsia, polyuria and nikturia, while children with RDM1 more frequently present with vomiting, nausea and abdominal pain. Children with NDM1 more often had decreased consciousness level. In our study, two children developed a cerebral edema. In order to minimize the incidence of children with DKA, constant education and reeducation of diabetics and their families as well as healthcare workers is important. It is important to continuously carry out public health education programs aimed at educating the population to early identify symptoms and signs of DM1. |
