Читать книгу Emergency Medical Services - Группа авторов - Страница 448

The SEARCH for Diabetes in Youth Study indicated that, during 2014‐2015, there were 24,049 newly diagnosed cases of diabetes among children and adolescents younger than 20 years; 18,291 had type 1 diabetes. Between 2002 and 2015, the overall incidence of type 1 and type 2 diabetes has significantly increased [3]. Prehospital clinicians should be alert for hyperglycemia in children with volume depletion, weight loss, polydipsia, and polyuria, as this may be the patient’s first presentation of diabetes. In addition, hypoglycemia should be suspected and glucose should be measured in any pediatric patient who has altered mental status, has volume depletion secondary to illness such as gastroenteritis, or for whom there is concern for medication overdose. In one study of children requiring resuscitation in an ED, 18% were found to be hypoglycemic, requiring administration of dextrose [24]. For the seizing pediatric patient, EMS clinicians should focus on early benzodiazepine administration. Hypoglycemia is a rare cause of pediatric seizures. Blood glucose should be measured if the patient continues to seize despite treatment or has a persistent altered mental status [38].

The prehospital management of pediatric hypoglycemia mirrors that of treatment in the adult. The recognition of hypoglycemia followed by administration of dextrose is paramount. Dextrose for children and infants should be diluted to at least 25% because dextrose is irritating to vascular structures. Because 10% dextrose is effective in children and adults, EMS systems may be able to carry a single concentration [18]. Table 20.2 provides guidance for treating hypoglycemia in pediatric patients using a D₁₀W solution. Hyperglycemia is treated with fluid resuscitation as appropriate, given the patient’s vital signs, with attention to the issue of potential cerebral edema discussed above.