rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2024-2-40-54rmt-2449Research ArticleКЛИНИЧЕСКАЯ ПРАКТИКАCLINICAL PRACTICEДиабетический кетоацидоз у детей: диагностика и интенсивная терапия (междисциплинарный консенсус на основе систематизации российского и зарубежного опыта)Diagnosis and Intensive Care in Children’s Diabetic Acidosis: an Interdisciplinary Viewpointhttps://orcid.org/0000-0002-2131-4813АлкусандровичЮ. С.AleksandrovichYu. S.

Юрий Станиславович Алкусандрович - заведующий кафедрой анестезиологии, реаниматологии и неотложной педиатрии, доктор медицинских наук, профессор.

194100, Санкт-Петербург, ул. Литовская, д. 2

Yuri S. Aleksandrovich

2 Litovskaya Str, 194100 Saint-Petersburg

jalex1963@mail.ruhttps://orcid.org/0000-0003-4653-4799ПрометнойД. В.PrometnoyD. V.

Дмитрий Владимирович Прометной - заместитель главного врача по анестезиологии и реаниматологии Российской детской клинической больницы, доктор медицинских наук, доцент.

119571, Москва, Ленинский пр-т, д. 117

Dmitry V. Prometnoy

117 Leninsky Prospekt, 119571 Moscow

prometnoy.d.v@gmail.comhttps://orcid.org/0000-0003-2500-8001ПетряйкинаЕ. Е.PetryaykinaE. E.

Елена Ефимовна Петряйкина - директор Российской детской клинической больницы, заведующая кафедрой эндокринологии педиатрического факультета, главный внештатный детский специалист-эндокринолог Министерства здравоохранения Российской Федерации по Центральному Федеральному округу, главный внештатный специалист-детский эндокринолог департамента здравоохранения г. Москвы, доктор медицинских наук, профессор.

119571, Москва, Ленинский пр-т, д. 117

Elena E. Petryaykina

117 Leninsky Prospekt, 119571 Moscow

lepet_morozko@mail.ruhttps://orcid.org/0000-0002-5578-5242КияевА. В.KiyaevA. V.

Алексей Васильевич Кияев -профессор кафедры госпитальной педиатрии, заведующий областным центром детской эндокринологии, главный внештатный детский специалист-эндокринолог Министерства здравоохранения Российской Федерации по Уральскому Федеральному округу, главный внештатный специалист-детский эндокринолог министерства здравоохранения Свердловской области, доктор медицинских наук.

Свердловская область, 620028, Екатеринбург, ул. Репина, д. 3

Alexey V. Kiyaev

3 Repin Str., 620028 Yekaterinburg, Sverdlovsk region

thyroend@mail.ruhttps://orcid.org/0000-0002-5507-4627ПетерковаВ. А.PeterkovaV. A.

Валентина Александровна Петеркова - заведующая кафедрой детской эндокринологии-диабетологии, главный внештатный детский специалист эндокринолог Министерства здравоохранения Российской Федерации, академик Российской академии наук, доктор медицинских наук, профессор.

117292, Москва, ул. Дмитрия Ульянова, д. 11

Valentina A. Peterkova

11 Dmitry Ulyanov Str., 117292 Moscow

lepet_morozko@mail.ruhttps://orcid.org/0000-0001-9956-7055КопыловВ. В.KopylovV. V.

Владимир Владимирович Копылов - главный врач клиники материнства и детства, главный внештатный специалист анестезиолог-реаниматолог комитета здравоохранения г. Санкт-Петербурга, кандидат медицинских наук, доцент.

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Vladimir V. Kopylov

2 Akkuratova Str., 197341 Saint Petersburg

kovlad72@mail.ruhttps://orcid.org/0009-0006-6628-2583МуратовП. А.MuratovP. A.

Петр Андреевич Муратов - заведующий отделением анестезиологии-реанимации.

190961, Санкт-Петербург, Лиговский пр., д. 8

Petr A. Muratov

8 Ligovsky Ave., 190961 St. Petersburg

kovlad72@mail.ruhttps://orcid.org/0000-0002-5923-4595БрезгинФ. Н.BrezginF. N.

Федор Николаевич Брезгин - доцент кафедры анестезиологии, реаниматологии, токсикологии, кандидат медицинских наук.

Свердловская область, 620028, Екатеринбург, ул. Репина, д. 3

Fedor N. Brezgin

3 Repin Str., 620028 Yekaterinburg, Sverdlovsk region

fedor-96@bk.ruhttps://orcid.org/0000-0002-1524-2577СтепаненкоС. М.StepanenkoS. M.

Сергей Михайлович Степаненко - профессор кафедры детской хирургии, главный внештатный детский специалист анестезиолог – реаниматолог Министерства здравоохранения Российской Федерации, доктор медицинских наук, профессор.

119571, Москва, Ленинский пр-т, д. 117

Sergey M. Stepanenko

117 Leninsky Prospekt, 119571 Moscow

steven54@mail.ruhttps://orcid.org/0009-0009-3017-1226ЛазукинА. В.LazukinA. V.

Александр Валерьевич Лазукин

620149, Екатеринбург, ул. С. Дерябиной, д. 32

Alexander V. Lazukin

32 S. Deryabina Str., 620149 Ekaterinburg

thyroend@mail.ruhttps://orcid.org/0000-0003-1113-5296ПшенисновК. В.PshenisnovK. V.

Константин Викторович Пшениснов - профессор кафедры анестезиологии, реаниматологии и неотложной педиатрии, доктор медицинских наук, доцент

194100, Санкт-Петербург, ул. Литовская, д. 2

Konstantin V. Pshenisnov

2 Litovskaya Str, 194100 Saint-Petersburg

psh_k@mail.ruАлехинаА. А.AlyokhinaA. A.

107031, Москва, ул. Петровка, д. 25, стр. 2

Alexandra A. Alyokhina

25 Petrovka Str., Bldg. 2, 107031 Moscow

Санкт-Петербургский государственный педиатрический медицинский университет Минздрава России РоссияРоссияState Pediatric Medical University, Ministry of Health of RussiaRussian FederationРоссийская детская клиническая больница-филиал Российского национального исследовательского медицинского университета им. Н.И. Пирогова Минздрава РоссииРоссияRussian Children's Clinical Hospital-Branch of N.I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaRussian FederationУральский государственный медицинский университет Минздрава РоссииРоссияUral State Medical University, Ministry of Health of RussiaRussian FederationНациональный медицинский исследовательский центр эндокринологии РоссияРоссияNational Medical Research Center for EndocrinologyRussian FederationНациональный медицинский исследовательский центр им. В.А. Алмазова Минздрава РоссииРоссияV.A. Almazov National Medical Research Center, Ministry of Health of RussiaRussian FederationДетский городской многопрофильный клинический центр высоких медицинских технологий им. К.А. РаухфусаРоссияRauchfuss Children's City Multidisciplinary Clinical Center for High Medical TechnologiesRussian FederationОбластная детская клиническая больница Свердловской областиРоссияRegional Children's Clinical Hospital Sverdlovsk AreaRussian FederationФедеральный научно-клинический центр реаниматологии и реабилитологииРоссияFederal Research and Clinical Center of Intensive Care Medicine and RehabilitologyRussian Federation2024250420242024054Copyright © Алкусандрович Ю.С., Прометной Д.В., Петряйкина Е.Е., Кияев А.В., Петеркова В.А., Копылов В.В., Муратов П.А., Брезгин Ф.Н., Степаненко С.М., Лазукин А.В., Пшениснов К.В., Алехина А.А., 20242024Алкусандрович Ю.С., Прометной Д.В., Петряйкина Е.Е., Кияев А.В., Петеркова В.А., Копылов В.В., Муратов П.А., Брезгин Ф.Н., Степаненко С.М., Лазукин А.В., Пшениснов К.В., Алехина А.А.Aleksandrovich Y.S., Prometnoy D.V., Petryaykina E.E., Kiyaev A.V., Peterkova V.A., Kopylov V.V., Muratov P.A., Brezgin F.N., Stepanenko S.M., Lazukin A.V., Pshenisnov K.V., Alyokhina A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/2449

Диабетический кетоацидоз (ДКА) — основная причина смертности и инвалидизации детей, страдающих сахарным диабетом первого типа (СД1). Смертность от СД1 у детей достигает 1% в развитых странах, 13% в развивающихся странах. Основная причина смерти при ДКА — отек головного мозга, клинические проявления которого развиваются у 0,5–0,9% детей с ДКА, а летальность достигает 24%.

Цель

Цель. Разработка рекомендаций на основе систематизации литературных данных и консолидированного мнения авторов по вопросам интенсивной терапии детей с диабетическим ацидозом для предотвращения развития жизнеугрожающих осложнений.

Материалы и методы

Материалы и методы. Изучили мнения экспертов по вопросам диагностики и лечения ДКА у детей с СД1 и 1200 литературных источников начиная с января 1970 г., опубликованных в российских рецензируемых научных журналах и зарубежных изданиях, представленных в онлайн репозитории Medline (Pubmed). Поиск публикаций осуществляли по ключевым словам: «дети», «ДКА», «СД1», дегидратация», «отек головного мозга».

Результаты

Результаты. Рассмотрели вопросы эпидемиологии, патогенеза, клиники, диагностики, интенсивной терапии при ДКА, а также клиники, диагностики, лечения, профилактики отека головного мозга у детей. Ограничениями исследования явилось небольшое количество современных исследований с высоким уровнем доказательности (рандомизированные контролируемые исследования, мета-анализы) за последние 5 лет, посвященных ДКА у детей.

Заключение

Заключение. С учетом обобщения российского и зарубежного опыта сформулировали рекомендации по диагностике ДКА, его ведущих осложнений и лечению детей с СД1 и ДКА. Своевременная и точная диагностика ДКА, интенсивная терапия с доказанной эффективностью, лабораторный и клинический мониторинг призваны прервать цепь патологических событий, предотвратить развитие жизнеугрожающих состояний и осложнений и улучшить исходы лечения детей с ДКА.

Diabetic ketoacidosis (DKA) is the main cause of death and disability in children with type I diabetes mellitus (T1DM). Children’s mortality from T1DM reaches 1% in developed countries and 13% in developing countries. The main cause of death in DKA is cerebral edema, clinical manifestations of which develop in 0.5–0.9% of children with DKA, while mortality riches 24%.

Objective

Objective. Developing recommendations to prevent life-threatening complications of children with DKA using analysis of literature data and consolidated opinion of experts on the issues of intensive care in children with T1DM.

Materials and methods

Materials and methods. We analyzed and discussed studies in diagnosis and treatment of DKA in children with type 1 diabetes and 1200 literature sources since January 1970, published in Russian peer-reviewed scientific journals and international publications presented in the online repository Medline (Pubmed). The search for publications was carried out using the keywords: «children», «DKA», «DM1», «dehydration», «cerebral edema».

Results

Results. We considered issues of epidemiology, pathogenesis, clinical manifestations, diagnosis, intensive care for DKA, as well as clinical and diagnosis, treatment, prevention of cerebral edema issues in children. Limitations of the study were the small number of modern studies with a high level of evidence (randomized controlled trials, meta-analyses) over the past 5 years on DKA in children.

Conclusion

Conclusion. Taking into account the national and international experience, joint recommendations on a consensus format were developed and formulated for the diagnosis of DKA, its leading complications and treatment recommendations for children with T1DM and DKA. Timely and accurate diagnosis of DKA, intensive therapy options based on proven therapeutic efficacy, laboratory and clinical monitoring are warranted to interrupt the DKA pathogenesis, prevent the development of life-threatening conditions, and improve treatment outcomes for children with DKA.

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The authors declare that there are no conflicts of interest present.