标题：以酮症酸中毒为首发症状的小儿糖尿病32例临床分析

      作者：魏雪梅，付 丹，张 琴
    （深圳市儿童医院急诊科，广东 深圳 518026）

      卷次： 2013年24卷8期

      【摘要】 目的 总结以酮症酸中毒(DKA)为首发症状的糖尿病患儿的临床特点及诊治经过。方法 回
顾性分析 32例以DKA为首发症状的糖尿病患儿的临床资料。结果 29例有多饮、多尿、消瘦表现；伴有呼吸
道感染者 16例，腮腺炎 1例，尿路感染 1例，消化道感染 2例，有恶心、呕吐、腹痛等消化道症状者 11例。32例
均有精神差、呼吸深大及脱水表现。给予补液、纠正酸中毒和电解质紊乱、胰岛素治疗后，所有病例均好转出
院。结论 以DKA为首发症状的糖尿病临床症状不典型，多由感染诱发，局部感染症状表现突出，容易漏诊误
诊。常规行血糖、血气分析、尿常规检查有助于诊断。一旦确诊后应立即予以补液、胰岛素降血糖、积极补钾、谨
慎补碱等对症综合治疗。

      【关键词】 糖尿病；糖尿病酮症酸中毒；胰岛素；儿童

      【中图分类号】 R725 【文献标识码】 A 【文章编号】 1003—6350（2013）08—1189—03


Clinical analysis of 32 children with diabetic ketoacidosis as the first symptom of diabetes mellitus.
WEI Xue-mei, FU
Dan, ZHANG Qin. Emergengcy Department, Shenzhen Children's Hospital, Shenzhen 518026, Guangdong, CHINA

【Abstract】 Objective To discuss the clinical features, diagnosis and treatment in children with diabetic keto-
acidosis (DKA) as the first symptom of diabetes mellitus. Methods Clinical data of 32 children with DKA as the
first symptom of diabetes mellitus were investigated retrospectively. Results Twenty-nine patients had clinical fea-
tures including polydipsia, polyuria and weight loss. There were 16 patients complicated with respiratory tract infec-
tion, 1 patient with mumps, 1 patient with urinary tract infection, 2 patients with gastrointestinal infection. Eleven pa-
tients had gastrointestinal symptoms of nausea, vomiting and abdominal pain. Poor spirit, deep respiration, dehydra-
tion existed in all the patients. All the patients were improved and discharged after treatment with fluid replacement, re-
dress acidosis and electrolyte disturbance, insulin supplement. Conclusion Clinical manifestations of diabetes melli-
tus with ketoacidosis as the first symptom are not specific. The inducement is always infection of which the symptoms
are outstanding. It's easy to be ignored or make misdiagnosis. We should increase vigilance on DKA when the children
have poor spirit or consciousness disorders, dehydration, deep respiration, vomiting and abdominal pain, unexplained
fatigue or weight loss. Blood glucose, arterial blood gas analysis and urine examination should be checked and once
the diagnosis is confirmed, the combined therapeutic measures are fluid replacement, insulin treatment,supplement of
potassium actively and redress acidosis carefully.