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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2008 March;74(3):93-5

lingua: Inglese

Treatment of severe diabetic acidosis with tris-hydroxymethyl aminomethane in a thirteen-year-old child

Marano M. 1, Iodice F. 2, Stoppa F. 1, Tomasello C. 1, Perrotta D. 1, Cecchetti C. 1, Di Nardo M. 1, Ciampalini P. 3, Pirozzi N. 1

1 DEA-Area Rossa, “Bambino Gesù” Pediatric Hospital , IRCCS, Rome, Italy;
2 PICU, “Bambino Gesù” Pediatric Hospital, IRCCS, Palidoro (RM), Italy;
3 Endocrinology Unit, “Bambino Gesù” Pediatric Hospital, IRCCS, Rome, Italy


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.

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