20xx年醫(yī)學(xué)專題—糖尿病酮癥酸中毒-英文ppt(編輯修改稿)
2024-11-14 04:32 本頁(yè)面
【文章內(nèi)容簡(jiǎn)介】 which contributes to normal or high initial serum potassium readings in DKA, even with profound total body deficits While insulin is administered and the hydrogen ion concentration decreases,the patient needs considerable potassium replacement.,第十六頁(yè)，共三十一頁(yè)。,Diagnostic Strategies,Laboratory Tests All laboratory determinations must be interpreted with caution. The diagnosis of pancreatitis is confounded by the usually elevated urine and serum amylase levels in DKA. Typically, this is salivary amylase, but most laboratories are not equipped to make this distinction. A serum lipase determination helps to distinguish pancreatitis from elevated salivary amylase levels.,第十七頁(yè)，共三十一頁(yè)。,Differential Considerations,Alcoholics, especially those who have recently abstained from drinking, with Kussmaul’s respiration, and acidemic ABG values may have alcoholic ketoacidosis.These patients may be euglycemic or hypoglycemic, Alcoholic ketoacidosis accounts for approximately 20% of all cases of ketoacidosis. Ketoacidosis can also develop with fasting in the third trimester of pregnancy and in nursing mothers who do not eat,第十八頁(yè)，共三十一頁(yè)。,Differential Considerations,Other entities that may manifest with various combinations of altered mental status, acidosis, and abdominal pain include hypoglycemia, cerebrovascular accident (stroke), trauma,sepsis, hyperglycemic hyperosmolar nonketotic coma, postictal states, lactic acidosis, uremic acidosis, and abdominal emergencies. Intoxications by ethanol, salicylates, methanol all share some features of DKA.,第十九頁(yè)，共三十一頁(yè)。,Management,General Measures The comatose patient, especially if vomiting, requires intubation. The patient in hypovolemic shock requires aggressive fluid resuscitation with 0.9% saline solution. When hyperglycemia,ketosis, and acidosis have been established, fluid, electrolyte,and insulin therapy should begin,第二十頁(yè)，共三十一頁(yè)。,Management,Dehydration The severely dehydrated patient is likely to have a fluid deficit of 3 to 5 L. Fluid rate should be adjusted according to age, cardiac status, and degree of dehydration to achieve a urine output of 1 to 2 mL/kg/hr. Fluid resuscitation alone may help to lower hyperglycemia.,第二十一頁(yè)，共三十一頁(yè)。,Management,Insulin DKA cannot be reversed without insulin, and insulin therapy should be initiated as soon as the diagnosis is certain. In the past, very high dosages of insulin were administered to diabetic pat
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