Ketosis, ketoacidosis, diabetic coma leading to incentives, symptoms and first aid

First, ketosis, ketoacidosis, diabetic coma leading to the incentive

1, diabetes, injury other than an acute infection.

2, eating sugary points, too much fat, insufficient food or taking insulin or interrupted.

3, large vomiting, diarrhea and hunger great.

4, cardiac infarction.

5, fatigue, stress and pregnancy.

Second, ketosis, ketoacidosis leading to the symptoms of diabetic coma

The original symptoms of diabetes increased, such as anorexia, thirst, urine and more fatigue, nausea, vomiting, body pain, headache, dizziness, and even a rotten apple breath, blood pressure, heart rate, difficulty breathing, unconscious and so on. The latter part of the patient showed severe dehydration, oliguria, dry skin, eye subsidence, Sheng Ya, blood pressure, cold limbs, hair. Late a variety of reflex disappeared or weakened, and coma.

Third, ketosis, ketoacidosis, diabetic coma leading to first aid

1, the patient is absolutely quiet in bed, to keep the mouth, the skin clean to prevent infection.

2, rehydration. 1000 ~ 2000ml normal saline intravenous drip to supplement the blood volume of solvent, improve blood circulation, kidney function and prevent low blood sugar. According to blood pressure, heart rate, urine decided to fluid velocity. Under the guidance of a doctor.

3, mild morning, there are ketones in urine, it can increase long before the dinner dose of insulin production.

4, as a result of starvation caused by ketosis, should oral glucose.

5, due to psychological stress, it can give intramuscular injection of insulin 20 units in the interim.

6, as a result of infection should control the infection.

7, should speed the timely diagnosis and treatment to the hospital.

Dr. Sperling said that this guide is the ADA’s first guidelines on the management of children in DKA, its content and management of adult DKA and non-ketotic hyperglycemic coma guide different, indicating ADA has recognized that children are not small adults, they have a special needs. Very young children with a history of diabetes difficult to collect, often misdiagnosed as pneumonia or other diseases, so doctors of any children of unknown etiology should be thought of the possibility of diabetes.

Dr. Sperling was also pointed out that children and adults, metabolic rate and body surface area were different, in the treatment of DKA in the process need to be more careful to correct children’s water and electrolyte metabolism imbalance. Very young children’s brains and other self-regulatory function have yet to develop comprehensive, must pay special attention to the occurrence of cerebral edema, which is the most common cause of death in children with DKA (incidence of 0.5% ~ 1%). In all survival after onset of DKA in children, about a quarter of the existence of permanent nerve injury. The guide also emphasized that delay in the diagnosis of diabetes is the main reason for children DKA, while the leakage of insulin use is the leading cause of recurrence of juvenile DKA.

Early identification of symptoms of juvenile diabetes, and metabolic decompensation in children with DKA prior to the implementation of treatment is feasible. Medical staff and the public, particularly school and kindergarten teachers should recognize that: Children I incidence of diabetes increasing in children as early as possible in case of suspicious to the doctor consultation. The physicians in the diagnosis and treatment of pediatric patients should also give more consideration to the possibility of diabetes.

(l) aggressive treatment of diabetes, adhere to a long-term strict control of blood sugar, do not arbitrarily interrupted insulin treatment, should be based on conditions at any time to adjust dosage.

(2) pay attention to preventing the occurrence of a variety of triggers, in particular the prevention of infection, to avoid the trauma and over-exertion. Even if there is fever, anorexia, nausea, vomiting, nor interruption of insulin therapy. But it should be an appropriate supplement their diets.

(3) Strict adherence to dietary regime is strictly prohibited alcohol, limiting fat and other fatty food intake. Poor diet and alcohol-induced ketoacidosis tend to be attention.

(4) When in a variety of stress state, such as severe infection, acute myocardial infarction, surgical critical care surgery, oral hypoglycemic drugs temporarily switch to insulin therapy to prevent ketoacidosis occurs.

(5) to keep alert on the disease from occurring, if there are ketones found in urine, we should promptly go to hospital for treatment.

【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.

(1) the establishment of special care. Close observation of blood pressure, heart rate, respiration, body temperature, consciousness, blood glucose, urine volume, urine sugar, Ketone body, blood gas analysis and electrolytes. 0.5 ~ 2 hours for each measurement of blood pressure, respiration, pulse once; mind out of quantity; every 2 hours check urine sugar and Ketone body once, 2 to 4 hours once a check of blood glucose and electrolytes.

(Two) oxygen. Patients should pay attention to suction of the coma in order to maintain airway patency. Qin stand up to burp, to prevent bedsores and hypostatic pneumonia from occurring.

(3) gastric dilatation gastric intubation.

(4), urinary retention catheter were inserted.

(5) Also in the treatment of lowering blood glucose, should not be too hasty to add lye to avoid hypokalemia, hypoglycemia, low blood osmotic pressure and brain edema and other complications; right just stop infusion patients, subcutaneous injection of insulin at night before going to sleep should 4 ~ 8U, in order to prevent the next morning there ketone bodies.

So, what is diabetic ketoacidosis? Hear his name Why is there ketoacidosis? Ketoacidosis is a rapid development of acute complications of diabetes, a dangerous condition. Its cause is lack of insulin caused by too many ketones generated. Ketones are acidic, and a large number of ketones accumulate in the body if it exceeded its normal range (normal human body is less than 2 cents ketones Mount / l) can cause metabolic acidosis. Lack of insulin secretion was more common in type 1 diabetes. We know that this diabetes need lifelong insulin injections. When a patient without authorization out of insulin, even if one or two, it is possible severe ketoacidosis. With type 2 diabetes Although it is generally not required insulin injections, in the event of a serious infection or inflammation, such as the won septicemia, pneumonia, purulent skin infections, acute pancreatitis or severe heart disease or stroke, major surgery or suffer a significant mental shock, or in a stress state, the body will secrete large amounts of cortical hormone. Against the role of this hormone insulin and promote the decomposition of the body’s metabolism, resulting in too many ketones generated. At this point, if disabled or less with hypoglycemic drugs, will be worse and more prone to ketoacidosis. Lao Li is due to pneumonia induced ketoacidosis.

Various symptoms

Patients with ketoacidosis, expressed initially as generalized weakness, anorexia. Nausea, vomiting, abdominal pain and other symptoms can occur, exactly like gastroenteritis. Patients can also have fever, severe thirst, increased urine volume in particular, mental dejected, and even coma. Because patients with eating, water reduction, coupled with acidosis and respiratory infections to accelerate, leading to severe dehydration caused by the body dry skin, dry lips, sunken eyes. There is breath in patients with severe ketoacidosis, ketone flavor (that rotten apple).

As the patient’s blood sugar high, urine volume increased, sugar from the urine discharge, they will naturally bring out a lot of water, it can appear severe dehydration, inadequate blood volume. And because ketones are acidic substances, can cause blood vessels to expand, and so further aggravate hypovolemia, hypotension, severe shock can occur. Blood pressure could not be determined. Ketones can also be combined with a large number of acidic environment within the destruction of patients, resulting in heart failure, kidney failure, brain cell edema. All of these are a serious threat to the patient’s life.

As Ketoacidosis is a dangerous life-threatening complications, its success depends on the availability of rescue and timely diagnosis and treatment. Therefore, once patients develop these symptoms should be immediately taken to hospital emergency rooms for examination and treatment. When treatment is best to bring family members in patients with prior medical history, and a variety of inspection report card. Such as blood sugar, electrocardiogram, etc., and tell your doctor promptly. If the patient conscious, should be encouraged to drink as much as possible. If a patient has urine, preferably pre-treatment with a clean urine bottles and containers to prepare for testing Ketone bodies.

Prevention Points

To avoid ketoacidosis, in particular, to keep in mind the following points:

1. For patients with type 1 diabetes can not be arbitrarily suspended insulin, in particular, can not believe in the so-called Jiang Hu Youyi argument can cure diabetes. If it is found he did not think of diet or infection occurs and can not arbitrarily stop eating, stop drinking, let alone out of insulin.

2. For patients with type 2 diabetes can not be easily interrupted effective treatment, frequent replacement therapy. When severe infection, heart attack or a severe mental shock, the doctor may recommend that you “temporary” use of insulin. At this point he must not refuse to insulin-Life “Friends.”

3. Peacetime to cultivate the habit of drinking plenty of water. Such as diabetes symptoms get worse, there unexplained weight loss, nausea, vomiting, etc., must be promptly check the blood sugar. If you find it difficult to ascertain the low blood sugar or high blood sugar, blood glucose and ketone bodies are unable to check, you can enable patients to try to drink a little sugar, if the symptoms do not improve they should immediately go to the hospital. If blood sugar more than 15 cents Mount / liter. Must check the U-KET. If the U-KET-positive, the patient can first drink 500-1000 ml of water (about two cups). Ketone bodies such as the continuing strong positive or positive, you must go to the hospital for further examination.

4. When the patients with serious heart attack or serious infection, then check Ketone at least twice a day. Remember When diabetes or other stress of exacerbations (such as fever, vomiting, etc.), must be to strengthen blood sugar, urine sugar, urine volume, and Ketone monitoring. To strengthen the link with the medical staff, seek professional medical guidance and帮助. Elderly diabetic ketoacidosis in patients with clinical manifestations may not be apparent, therefore, once the feeling and usually “different” should arouse vigilance and timely to the hospital to be checked.

(1) Ⅰ diabetes patients in order to disable or reduce the excessive insulin is the most common incentives for individual patients can produce insulin resistance.

(2) infection is a common incentive to acute infection or acute attacks of chronic infection more common. One of the most common respiratory tract, urinary tract and gastrointestinal infections. Members easily cause infection accompanied by vomiting and ketosis.

(3) stress state, such as surgery, trauma, fractures, childbirth, anesthesia, pregnancy, acute myocardial infarction, cerebrovascular accident, hyperthyroidism, are induced ketoacidosis.

(4) the spirit of factors, such as trauma, mental stress and over-excited and so on.

(5) eating disorders. Excessive consumption of sugary and fatty foods, excessive drinking or excessive restrictions on carbohydrates, the amount of less than 100 grams per day.

(6) Diabetes does not control or exacerbations.

In the event of coma in patients with diabetic ketoacidosis are generally a precursor to the former, and outstanding performance are: fatigue, marked anorexia, nausea, vomiting, extreme thirst, urine volume significantly more than usual; also often dizziness, headache, expression of indifference, lethargy, irritability, breathing deepened to speed up; some exhaled gases of patients with rotten apple. Further deterioration, then decreased urine output, dry skin, eye subsidence, rapid pulse slim and fragile and is not structured, blood pressure, cold limbs. Small number of patients, there may be abdominal pain, or even be misdiagnosed as acute abdomen.

Disease observation:

1. Ketoacidosis occurs in patients with progressive fatigue, weakness, extreme thirst, anorexia, nausea, and vomiting.

2. Tachypnea, expiratory time to time one flavor (smell like rotten apples).

3. With the increased water loss dehydration, decreased urine output, skin dry and inelastic, eye subsidence.

4. Severe shock can be expressed as heart rate, pulse small velocity, blood pressure, limb Jueleng so, the patient was tired to sleep and gradually into a coma.

5. Experimental checks, blood glucose increased significantly decreased blood carbon dioxide combining power, blood ketones increased, urine sugar strong positive, Ketone-positive white blood cell counts increased and so on.

Symptomatic care:

1. Diagnosed with ketoacidosis, the absolute bed rest, with life-saving treatment immediately.

2. Quickly establish intravenous access, correct water, electrolyte and acid-base balance disorders, to correct symptoms of ketosis.

3. The doctor’s advice to use regular insulin. Application of small doses of insulin pump doses to the right in order to reduce hypoglycemia, hypokalemia, cerebral edema.

4. Assist in handling-induced disease and complications, close observation of vital signs, consciousness and pupil (see coma care routine) to help make the determination of blood glucose and records.

5. Food Care fasting until after the change to alleviate diabetic coma or semi-liquid diet diabetes.

6. The prevention of infection must be prepared oral and skin care to keep the skin clean to prevent bed sores and secondary infections, female patients should be kept outside the perineum clean.

7. Vascular disease diabetes, general nursing care according to Chu, the under the different parts or organs of the vascular lesions in nursing.

8. Neuropathy care, control of diabetes, applied a lot of vitamin B, partial massage and physical therapy, lost feeling on the skin should be taken to avoid damage.

9. Good health guidance, so that patients or their families to grasp the knowledge of diabetes and establish the confidence of disease-fighting

When a serious lack of insulin, the body caused by abnormal hormone secretion, glucagon, growth hormone, catecholamines, and cortisol and other hormones on glucose and fat metabolism increased, to promote glycogen breakdown, glucose xenobiotic improved blood sugar levels and accelerate the decomposition of fat to produce an increase in ketone bodies, but also led to accumulation of blood groups.

Acetic acid and β-hydroxybutyric acid as a strong organic acids. They accumulate in the blood, the acidic metabolites increased, so that the blood PH value (acidity) decreases; as acidic metabolites from the tubular discharge when combined with the base, the body’s alkaline reserves continue to be lost, so that the blood PH value of the further decline in blood CO2 binding is also significantly reduced. At this time attached to the blood continues to increase, in excess of 5 mmol / l, expressed as metabolic acidosis, or diabetic patients attached to acidosis.

Secondly, can cause multiple organ damage. An increase in blood sugar and blood ketone bodies, have diuretic effects. Induces a large number of acidic substances, with the discharge of urine when you take away a lot of water and sodium, potassium and other electrolytes, easily result in dehydration and electrolyte imbalance. Acidosis, dehydration and electrolyte disorders, neurological dysfunction can. In severe cases, coma, blood pressure, shock and even death. Too much too fast if rehydration therapy, but also lead to heart failure. In the electrolyte imbalance, particularly hypokalemia or hyperkalemia, based on the often can lead to cardiac arrhythmia and even cardiac arrest. When the blood glucose, serum sodium fell too fast, can also lead to cerebral edema, coma deepened, the higher fatality rate. Acute renal failure are also common. Ketoacidosis can also lead to the original infection and sepsis further aggravated serious can lead to disseminated intravascular coagulation (DIC).