ALGORITMO DE TRATAMIENTO DE LA CETOACIDOSIS DIABETICA EN PEDIATRIA





ALGORITMO DE TRATAMIENTO DE LA CETOACIDOSIS DIABETICA EN PEDIATRIA

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El monitoreo de la glucemia y de los electrolitos séricos es la base para un tratamiento exitoso en la cetoacidosis diabética, sobre todo para evitar el edema cerebral, que es la complicación más grave.
Autor:
Jesús Javier Martínez García
Columnista Experto de SIIC

Institución:
Universidad Autonoma de Sinaloa


Artículos publicados por Jesús Javier Martínez García
Recepción del artículo
8 de Diciembre, 2009
Aprobación
14 de Diciembre, 2009
Primera edición
15 de Julio, 2010
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
La cetoacidosis diabética (CAD) es la complicación más importante de la diabetes mellitus. La piedra angular para el diagnóstico de la CAD son la historia clínica y la exploración física, en ellas generalmente encontramos los factores precipitantes y podemos clasificar el estado de hidratación del paciente. Los estudios de laboratorio son de gran utilidad para monitorizar la hiperglucemia, el estado ácido-base y el desequilibrio electrolítico inicial. La terapia inicial durante la primera hora es administración de líquidos intravenosos, generalmente cristaloides, con revaloraciones del estado de hidratación y de los niveles séricos de potasio antes de comenzar el tratamiento con insulina, que debe hacerse en la segunda hora. El monitoreo de la glucemia y de los electrolitos séricos es la base para un tratamiento exitoso en la CAD, sobre todo para evitar el edema cerebral, que es la complicación más seria. Afortunadamente, dicha complicación es rara y uno de los factores de riesgo asociados es el tratamiento inadecuado; si bien se han propuesto otros factores de riesgo, no están totalmente identificados.

Palabras clave
cetoacidosis diabética, tratamiento, edema cerebral


Artículo completo

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Abstract
Diabetic ketoacidosis (DKA) is the most important complication of diabetes mellitus. Medical history and physical examination are the cornerstones for DKA diagnosis, since they generally allow the physician to discover the precipitating factors and to determine the degree of patient dehydration. Laboratory work-up is very useful to monitor hyperglycemia, acid-base status and electrolytic imbalance at baseline. The goal of the first hour of treatment is fluid administration, generally of intravenous crystalloids, with reassessment of hydration status and potassium levels before starting insulin treatment, which should be initiated at the second hour. Blood glucose and electrolyte serum level monitoring is essential for a successful treatment of DKA, mainly to avoid cerebral edema, which is the most serious complication of DKA. Fortunately such complication is rare. One of the risk factors associated to cerebral edema is the use of inadequate treatment or the use of some therapies that have been proposed which results are unclear.

Key words
diabetic ketoacidosis, treatment, cerebral edema


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Pediatría
Relacionadas: Bioquímica, Cuidados Intensivos, Diabetología, Diagnóstico por Laboratorio, Endocrinología y Metabolismo, Medicina Familiar, Medicina Interna, Nutrición



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Jesús Javier Martínez García, Sinaloa, México
Bibliografía del artículo


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