Symptomatic cerebral oedema during treatment of diabetic ketoacidosis effect of adjuvant octreotide infusion 英文参考文献.docVIP

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Symptomatic cerebral oedema during treatment of diabetic ketoacidosis effect of adjuvant octreotide infusion 英文参考文献.doc

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Symptomatic cerebral oedema during treatment of diabetic ketoacidosis effect of adjuvant octreotide infusion 英文参考文献

Seewietal.DiabetologyMetabolicSyndrome2010,2:56 /content/2/1/56 DIABETOLOGY METABOLIC SYNDROME CASE REPORT OpenAccess Symptomaticcerebraloedemaduringtreatment ofdiabeticketoacidosis:effectofadjuvant octreotideinfusion OraSeewi*,AnneVierzig,BernhardRoth,EckhardSch?nau Abstract Introduction:Apotentiallylethalcomplicationofdiabeticketoacidosis(DKA)inchildrenisbrainoedema,whether causedbyDKAitselforbythetherapeuticinfusionofinsulinandfluids. Casepresentation:A10-yearoldpreviouslyhealthyboywithDKAbecameunconsciousandapnoeicdueto cerebraloedema(confirmedbyabnormalEEGandCT-scan)duringtreatmentwithintravenousfluids(36ml/h)and insulin(0.1units/kg/h).Hewasintubatedandartificiallyventilated,withoutimpactonEEGandCT-scan. Subsequently,adjuvantinfusionofoctreotidewasapplied(3.5μg/kg/h),suppressinggrowthhormone(GH)and IGF-1productionandnecessitatingtheinsulindosetobereducedto0.05-0.025units/kg/h.Thebrainoedema improvedandtheboymadeafullrecovery. Conclusion:Co-therapywithoctreotidewasassociatedwithafavourableoutcomeinthepresentpatientwith DKAandcerebraloedema.Whetherthiscouldbeascribedtotheeffectsofoctreotideontheinsulinrequirement orontheGH/IGF-axisremainstobeelucidated. Introduction DKAbyBosnaketal.[12].Theseauthorsaddedasoma- Cerebral oedema is the most feared complication of tostatin infusion to the standard DKA therapy in two DKA.Thepathogenesis appears complex andispoorly unconscious children with DKA who subsequently understood [1].According toarecentworkinghypoth- regainedconsciousnesswithin3-4hours.Thetherapeutic esis,dehydrationandhypocapniadiminishcerebralper- mechanism of somatostatin in this condition remains fusion,resultinginmildbrainischaemiaandsubsequent obscure. Weprovide additional evidence fortheuseof cytotoxicandvasogeniccerebraloedema[1].Inthiscon- somatostatintoimprovetheoutcomeofcerebraloedema text,hypoxia-inducedVEGFactivitymayplayarole[2]. inchildhoodDKA. Insulintreatmentmightalsocontribute,forexamplevia its sodium-retaining e