Aspects of diabetic ketoacidosis
Posted on February 4, 2010
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Acute complications of diabetes, diabetic ketoacidosis is also a common accident and emergency medicine, one of the event, should be actively treated.
【Incentive】
Patients with type 1 diabetes tend to occur with diabetic ketoacidosis, type 2 diabetes in certain incentives may also occur under the action of diabetic ketoacidosis, a common incentive to infection, insulin treatment interruption or improper reduction, poor diet, trauma , surgery, pregnancy and childbirth, and sometimes no obvious incentive.
Clinical manifestations 【】
Most of the patients in the event of disturbance of consciousness a few days before more urine, polydipsia polydipsia and fatigue, followed by anorexia, nausea, vomiting, often accompanied by headache, lethargy, irritability, breathing deep fast, there are rotten apple breath (acetone ). As the disease further development, severe dehydration, decreased urine output, skin elasticity is poor, the eye subsidence, thin-speed pulse, blood pressure drop. To late for the various reflex slow or even disappear, lethargy and even coma. Infections caused by clinical manifestations of incentives may be overshadowed by the performance of DKA. A small number of patients showed abdominal pain, resembles acute abdomen, often misdiagnosed and should be pay attention. Some patients with diabetic ketoacidosis as the first performance.
【Laboratory tests】
First, uric sugar, Ketone body of strong positive. When the renal function of serious damage threshold increased, the glucose, Ketone-positive degree of blood glucose, blood ketone values is not commensurate. May have proteinuria and casts in urine.
Second, the majority of blood glucose 16.7 ~ 33.3mmol / L (300 ~ 600mg/dl), and sometimes up to 55.5smmol / L (1000mg/dl) above. Blood ketone bodies increased, mostly in 4.8mmol / L (50mg/dl) or more. To reduce carbon dioxide combining power. Light who is 13.5 ~ 18.0mmol / L (30 ~ 40vol%), weight in the 9.0mmol / L (20vol%) below. To reduce carbon dioxide partial pressure, pH <7.35. Increased negative base excess (>-2.3mmol / L). Increased anion gap, and bicarbonate to reduce roughly equal. Normal or low serum potassium minimize after high hypokalemia can occur after treatment. Serum sodium, serum chloride reduction. Blood urea nitrogen (BUN) and creatinine often high. Elevated serum amylase can be found in 40% ~ 75% of patients after treatment, 2 ~ 6 days to normal. Mild increase in plasma osmolality. WBC increased, the proportion of neutrophils increased.
【Diagnosis and differential diagnosis】
Of coma, acidosis, dehydration, shock patients, should consider the possibility of DKA. Especially unexplained disturbance of consciousness, there is one breath smell, blood pressure, urine output is low and there are still many who should be timely for the relevant tests to gain Early diagnosis and timely treatment. A small number of patients with diabetic ketoacidosis as the first manifestation of diabetes in some cases due to other diseases or predisposing factors are also easy to chief complaint medical staff thinking astray. Some patients with diabetic ketoacidosis and uremia or cerebral vascular accident coexistence Ershi condition is more complex, should pay attention to identify. In addition, should be low blood sugar coma, hyperosmolar nonketotic diabetic coma and lactic acidosis between the identification.
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