Cetoacidose diabética em crianças: revisão da fisiopatologia e tratamento com o uso do “método de duas soluções salinas”

Abstract

Este trabalho teve o apoio da Genentech Foundation for growth and development. Abstract Objectives: To review diabetic ketoacidosis, including the “two bags system”, a method of administering liquids in order to provide a smoother correction of the hyperglycemic and ketotic states. Methods: Review of recent publications (last 7 years) from a Medline search and chapters published in pediatric textbooks that discuss the etiology, therapy, and complications of diabetic ketoaci-dosis. The management approach incorporates the findings of these publications as well as the clinical experience at the Children’s Hospital of Philadelphia and Duke University Medical Center. Results: The pathology of the type 1 Diabetes Mellitus involves the progressive destruction of the ß cells of the pancreas, causing insulin deficiency. Insulin is essential in the metabolism of carbohy-drates, protein and fat. Insulin deficiency may lead to diabetic ketoacidosis which has three components: 1) hyperglycemia, which causes glycosuria and consequently dehydration; 2) lipolysis which, causes ketonemia/ketonuria; and 3) acidosis, that is caused by the dehydration and the high serum levels of ketones. Diabetic ketoaci-dosis is a serious condition and, if not treated appropriately, can cause coma and death. In children cerebral edema is the major complication of the therapy for diabetic ketoacidosis. Careful re-placement of insulin, fluids, glucose and electrolytes is essential.