Cetoacidosis diabética en unidades de terapia intensiva pediátricas de argentina. Estudio multicéntrico.
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Abstract
Introducción:
La cetoacidosis diabética (CAD) resulta de una deficiencia de insulina asociada a un aumento de hormonas contrarreguladoras. Acarrea una mortalidad entre el 0,15 y el 0,30%, siendo el edema cerebral su principal causa. La terapéutica de la CAD se basa en la hidratación, insulinoterapia, administración de electrolitos, además del tratamiento del factor precipitante.
Objetivo:
Determinar la incidencia de CAD en UTIPs durante el período 01/01/2013 a 31/12/2017.
Describir y analizar los datos epidemiológicos, el tratamiento instaurado y determinar la existencia de factores predictores de edema cerebral.
Pacientes y Métodos:
Todos los pacientes con diagnóstico de CAD ingresados en 8 UTIP de 7 hospitales de Argentina.
Resultados:
La incidencia de CAD en las UTIP fue del 6‰. Se analizaron 56 casos, edad de 11 años (8-14). El 53,6% fueron Diabetes Mellitus debut, presentando al ingreso pH 7,07 (6,96-7,13) y HCO3 de 5 mEq/L (3,65-6,7) respectivamente. El volumen de líquidos EV aportados mediante PHP en las primeras 24 horas fue de 4050 (3200-4520) ml/m2. El 43% de los pacientes presentó edema cerebral clínico. El PIM II, el PH y estado neurológico al ingreso, la administración de HCO3, el volumen de líquidos aportado y la dosis acumulada de insulina se asociaron con edema cerebral (p<0,05). La estancia en la UTIP fue de 3 días (2-5) y la mortalidad del 3,6% (2/56).
Conclusión:
La incidencia de CAD fue del 6‰. La severidad de la CAD, el aporte de HCO3, la hiperhidratación y la mayor dosis acumulada de insulina se asociaron a edema cerebral.
Summary:
Introduction:
Diabetic ketoacidosis (DKA) results from an insulin deficiency combined with an increase in counterregulatory hormones. It carries a mortality between 0.15 and 0.30%, being the cerebral edema the main cause of death. DKA treatment is based on hydration, insulin therapy, administration of electrolytes, in addition to the treatment of the triggering factor.
Objective:
To determine the incidence of DKA in pediatric intensive care units (PICU) during the period 01/01/2013 to 12/31/2017.
To describe and analyze the epidemiological data, established treatment and to determine the existence of predictors of cerebral edema.
Patients and Methods:
All patients with diagnosis of DKA admitted to 8 PICU of 7 hospitals in Argentina.
Results:
DKA incidence in PICU was 6 ‰. We analyzed 56 cases, median age of 11 years old (8-14). The 53.6% were Diabetes Mellitus (DM) debut, presenting at the admission time, pH 7.07 (6,96-7,13) and HCO3 of 5 mEq/L (3,65-6,7), respectively. The IV fluid volume provided by PHP in the first 24 hours was 4050 (3200-4520) ml/m2. The 43% of patients presented clinical cerebral edema. PIM II, PH and neurological status at admission time, HCO3 administration, fluid volume provided and insulin cumulative dose were associated with cerebral edema (p <0.05). The length of PICU stay was 3 days (2-5) and the mortality was 3.6% (2/56).
Conclusion:
DKA incidence in PICU was 6 ‰. DKA severity, HCO3 supply, hyperhydration and high insulin accumulated dose were associated with cerebral edema.
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