儿童糖尿病酮症酸中毒13例误诊分析

Analysis of Misdiagnosis of Diabetic Ketoacidosis in Children(13 Cases)

目的探讨儿童糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)的误诊原因及其防范措施,以提高早期诊断率。方法回顾分析2001年1月～2010年12月我院儿科收治的13例DKA误诊病例的临床资料。结果本组均无糖尿病病史,2例有糖尿病家族史;8例因感染诱发,3例因饮食不当诱发,2例无明显诱因;主要表现为急性呼吸道感染、消化道和神经系统症状、体征。误诊为急性胃肠炎4例,病毒性脑炎及肺炎各3例,急性胰腺炎2例,肾结石1例。误诊时间3 h～3 d。确诊后经积极综合治疗,12例抢救成功,1例死亡。结论提高对儿童DKA的警惕性,详细询问病史,认真查体并完善相关医技检查,可降低儿童DKA的误诊率。

Objective To increase the early diagnosis rate of diabetic ketoacidosis（DKA） in children by investigating its misdiagnosis causes and preventive countermeasures.Methods Clinical data of 13 misdiagnosed cases of DKA in children during January 2001 and December 2010 were retrospectively analyzed. Results All children had no history of diabetes and 2 children had a family history of diabetes.8 children were caused by infection,3 children by improper diet and 2 children had no obvious incentive factor.DKA in children were characterized as acute respiratory infections,gastrointestinal and neurological symptoms and signs.In all patients,4 cases were misdiagnosed as acute gastroenteritis,3 cases as pneumonia,3 cases as encephalitis,2 cases as acute pancreatitis,1 cases as renal calculi.There was 3 h-3 d delay before DKA was finally diagnosed.After active treatment,12 children were saved successfully and one child died. Conclusion We should increase vigilance on DKA in children.Detailed history-taking and physical examination,and necessary auxiliary examinations can reduce and misdiagnosis rate of DKA in children.