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.

Although the complications of diabetes is terrible, but as long as blood pressure, blood glucose, blood lipid control in relatively good long-term stable state, to the complications of diabetes will be able to say “no.” In daily life, develop a healthy and regular lifestyle is essential in diabetic patients. To prevent or delay the occurrence and development of complications, diabetes patients must first maintain the mood of optimism, to avoid the extreme emotional or mental stress; followed insist on work and rest, to participate in appropriate recreational activities, sports and manual labor, to avoid fatigue and nervous activity; in their daily diet to do with science and nutrition to maintain the standard weight, bogey is sweet and spicy food and alcohol and tobacco; diabetic patients taking hypoglycemic agents, it is necessary to grasp the blood sugar drop, adjusting the amount of drugs in order to avoid low blood sugar reactions. Patients with diabetes must pay attention to foot and skin care, maintenance of sanitation, prevention of infection, gangrene from happening. Clothing, shoes and socks should be loose and soft. When they find out there is dry, rough, easy to crack the skin, should always smear moisturizing lotion to keep skin moist and prevent skin cracking. Because the foot skin feeling weakened, so both feet can easily burn, so do not get too close to the heating object.

Because of the high incidence of diabetic complications in recent years, World Diabetes Day theme is diabetes complications related to diabetes, this year’s theme is “Diabetes and obesity.” As a leading company in diabetes care, Novo Nordisk has always been to improve the quality of life for patients with responsibility, and diabetes set up a “Novo Care” series of services. In the popular diabetes prevention, care and treatment knowledge, raising the public awareness of diabetes.

China Academy of Traditional Chinese Medicine with the endocrinologist, Professor Kobayashi explained that the clinical diabetes with frozen shoulder are not uncommon. Diabetes, early, middle and late there may be complicated by frozen shoulder. As for why people with diabetes complicated by frozen shoulder, its mechanism is not very clear. Now that may be due to the high blood sugar diabetes easy to damage the small blood vessel walls, thus affecting the blood supply, causing local swelling. This lesion occurred in soft tissue around the shoulder joint, especially the Ministry of shoulder easy to wear and aging, tendons and joint capsule Department, increased the department’s inflammatory response, and induce a frozen shoulder.

Once the diagnosis of frozen shoulder because of diabetes, in the strict control of blood glucose, based on the need for local treatment. Commonly used massage, acupuncture, cupping, acupuncture massage, drug fumigation and so on, with the Oral Qufeng cold-dispelling, Shujin vibrant, swelling pain efficacy of Chinese and Western medicine. With the professor warned diabetics to acupuncture, cupping and other therapy, should be particularly careful to avoid injury. Because diabetes difficult to heal the wounds of the skin can easily lead to infection.

According to Prof. Xu introduced the main hazard is the complications of diabetes can be said that, diabetes, high blood sugar diabetes complications, more terrible than that. Detection of diabetic complications of traditional genes carried through the blood, this approach will lead to patients with trauma, pain, as well as the risk of cross infection.

In order to solve these problems, the last century, 90 years, the research team led by Professor Xu began to study the non-blood cells in diabetes and its complications related genes and found oral exfoliated cells and blood leukocytes in the consistency of the results of DNA testing is 100% . The last two years, the National dozen or so units renowned medical clinical practice confirmed by detection of exfoliated cells of oral complications of diabetes is a kind of drawn simple, safe and painless, non-polluting and cross-infection. At the same time, this method is easy to identify high-risk groups, is conducive to early diagnosis and early treatment.

Outside the Beijing Cancer Hospital, 2 Hepatobiliary and Pancreatic Professor Hao Chunyi, director of presentations, high-fat, high-calorie food, a large number of high-cholesterol intake, as well as smoking, alcohol abuse, such as bad sedentary lifestyle, makes it a great burden on the pancreas, The total incidence of pancreatic cancer has also been an upward trend, and the emergence of a younger age trend.

In addition to these risk factors, there is a risk factor for pancreatic cancer is a diabetic. The study found that more than five years duration of diabetes in patients with pancreatic cancer risk is higher than in normal group. Because patients with diabetes will have an excessive amount of insulin, which may facilitate the location of pancreatic cancer cells growth. Experts have warned that the new diabetes mellitus in patients with pancreatic cancer to improve vigilance, if only the treatment of type Ⅱ diabetes while ignoring the possibility of pancreatic cancer, resulting in ineffective treatment by diabetes, it is likely to lose the timing of surgical cure of pancreatic cancer. In addition, patients with chronic pancreatitis and genetic family history of people and pay attention to screening for pancreatic cancer.

In addition, Hao Junki also cautioned that the early onset of pancreatic cancer often no obvious symptoms, with the growth of tumors and then gradually appear on the abdominal discomfort, pain, anorexia, nausea, vomiting, diabetes, weight loss, jaundice and back pain, etc., and proposed that patients with such symptoms as early as possible to the Cancer Hospital to exclude tumor disease.

【Yi】

Advised to eat to enhance immunity, anti-pancreatic cancer effect of food, such as soft-shelled turtles, turtles, sturgeon, shark, mackerel, shad, snakes, yams, beans, mushrooms, jujube.

【Bogey】

Ji greasy and high in animal fat foods, bogey eating and drinking, eating fullness, quit smoking, alcohol and spicy spicy food, bogey mildew, fried, smoked, pickled food, bogey hard, sticky foods do not digest.

Typical Case

Patients with old Yan, 74-year-old, recently had no incentive to cough, cough even white sticky sputum, no chills, fever, stuffy nose, runny nose, no hemoptysis, night sweats and other symptoms. Self-serve some cold medicine, but no improvement in cough. Since the onset, non-progressive weight loss. Vital signs were stable. Coarse breath sounds lungs, both lungs at the end of audible sound and fine wet, heart rate ranged from 180 to 200 times. Denied coronary heart disease, high blood pressure, history of chronic diseases.

After admission chest X-ray film prompted a large dense shadow right lower lung, lung markings thickening. ECG examinations showed rapid atrial fibrillation. With a history of initial diagnosis: 1. Bronchial infection. 2. Secondary pulmonary tuberculosis? 3. Rapid atrial fibrillation (coronary heart disease?). The next day the test results in accordance with the diagnosis of type 2 diabetes was established.

Take into account not just for the lung lesions in patients with infections, tuberculosis should be excluded. But the patient was dry cough, sputum can not be OK. Cha tuberculin test was negative tuberculin test (PPD) negative. The last line of the chest CT examination was prompted to the left lung and a small amount of secondary-type tuberculosis pleural effusion.

Doctors Comments

Survey shows that diabetes is complicated by the risk of cardiovascular disease in non-diabetic patients with 2 to 4 times. This course in patients with no “chest pain, chest tightness, palpitations” and so clinical symptoms of coronary heart disease. Was mainly due to diabetes, longer duration, causing cardiac autonomic neuropathy, causing pain caused by lack of myocardial ischemia, when myocardial ischemia or heart rate is often no obvious sense, there painless angina, masked the symptoms of coronary heart disease.

Diabetes, and tuberculosis patients and higher than normal risk of 4 ~ 8 times. More men than women, the incidence rate increased with age, showed an upward trend. Two diseases affecting each other, diabetes, tuberculosis treatment for the adverse effects of a relatively significant, must be based on the control of diabetes and tuberculosis treatment can be effective. Chemotherapy of pulmonary tuberculosis and diabetes programs should be appropriately extended. The patients with atypical symptoms of tuberculosis, no low-grade fever, night sweats, chest pain, hemoptysis, weight loss and other symptoms of poisoning, tuberculosis, combined with a dry cough without sputum, sputum can not be OK. PPD test is negative, to bring some difficulties in diagnosis. Last on chest CT, clinical experience and efficacy of the final diagnosis of tuberculosis diagnosis.

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