title: Treatment of severe diabetic acidosis with tris-hydroxymethyl aminomethane in a thirteen-year-old child.
abstract: Diabetic ketoacidosis is a severe complication of type I diabetes. A 13-year-old female (40 kg) patient was admitted to our Intensive Care Unit with severe metabolic acidosis (pH: 6.8), hyperglycemia (835 mg/dL) and coma. Her hemodynamic conditions were unstable and, even though a large amount of plasma expanders, crystalloids, and inotropic support were supplied, the patient went into cardiac arrest in the first hour of treatment. After resuscitation, a better hemodynamic balance was achieved and metabolic acidosis was treated with fluid replacement therapy, continuous insulin infusion, and Tris-hydroxymethyl aminomethane (THAM) as a buffering agent. This therapy rapidly improved her metabolic conditions. The patient was discharged 5 days after Intensive Care Unit admission in good condition and without neurological sequelae.
authors.affiliation: DEA-Area Rossa, Bambino Gesù' Pediatric Hospital , IRCCS, Rome, Italy. marcomarano@yahoo.it
authors.forename: M
authors.initials: M
authors.lastname: Marano
authors.forename: F
authors.initials: F
authors.lastname: Iodice
authors.forename: F
authors.initials: F
authors.lastname: Stoppa
authors.forename: C
authors.initials: C
authors.lastname: Tomasello
authors.forename: D
authors.initials: D
authors.lastname: Perrotta
authors.forename: C
authors.initials: C
authors.lastname: Cecchetti
authors.forename: M
authors.initials: M
authors.lastname: Di Nardo
authors.forename: P
authors.initials: P
authors.lastname: Ciampalini
authors.forename: N
authors.initials: N
authors.lastname: Pirozzi
mesh_terms: D000293:Adolescent; D016883:Diabetic Ketoacidosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D012720:Severity of Illness Index; D014325:Tromethamine / Q000627:therapeutic use*
chemical_list: D014325:Tromethamine