内分泌
词汇介绍
拓展阅读
解析
diabetic 英 /daɪə'betɪk/ 美 /,daɪə'bɛtɪk/
释 义 adj. 糖尿病的，患糖尿病的；n. 糖尿病患者
同根词 diabetes n. 糖尿病；多尿症
例 句 Not all people with insulin resistance are diabetic, and some never develop diabetes, but they are at a much higher risk for the disease. 患有胰岛素抵抗综合症的人并不都是糖尿病患者，有的永远不会患糖尿病，但是他们患的几率更大。
ketoacidosis 英 /,ki'təuæsi'dəusis/
释 义 n. [内科] 酮酸中毒；酮病
同根词 ketosis n. [内科] 酮病
例 句 The blood β-HBA and urine ketone were monitored during the management of 18 patients with diabetic ketosis or ketoacidosis. 在18例糖尿病酮症或酮症酸中毒患者的治疗过程中，同时监测血酮和尿酮。
概述
概述
糖尿病酮症酸中毒（DKA）是一种严重的疾病，可导致糖尿病昏迷（长时间昏迷）甚至死亡。DKA可发生在任何患有糖尿病的人身上，但在2型糖尿病患者中很少见。
原因
①疾病：感染或其他疾病可导致您的身体产生更高水平的某些激素，如肾上腺素或皮质醇。不幸的是，这些激素抵消了胰岛素的影响-有时引发了糖尿病酮症酸中毒的发作。肺炎和尿路感染是常见的罪魁祸首。
②胰岛素治疗的问题：错过胰岛素治疗或胰岛素治疗不足会使您系统中的胰岛素过少，从而引发糖尿病酮症酸中毒。
③身体或情绪创伤。
④心脏病发作。
⑤酒精或药物滥用，尤其是可卡因。
⑥某些药物，如皮质类固醇和一些利尿剂。
诊断方法
糖尿病酮症酸中毒症状通常在24小时内迅速发展。对于一些人来说，这些症状和体征可能是患糖尿病的第一个迹象。你可能会注意到：过度口渴、尿频、恶心和呕吐、腹痛、虚弱或疲劳、呼吸急促、烂苹果味浓郁的气息
糖尿病酮症酸中毒的更具体迹象可通过血液和尿液检测试剂盒检测，包括：高血糖水平、尿液中酮含量高。
预防
①控制糖尿病；②监测血糖水平；③根据需要调整胰岛素剂量；④检查酮水平；⑤准备好紧急救治。
复制标题糖尿病酮症酸中毒的初始管理和糖尿病类型的预后: 一项法国多中心观察性回顾性研究
发表时间：2019-08-15
影响指数：3.9
作者： Adrien Balmier
期刊：ANN INTENSIVE CARE
Precipitating causes of DKA confrmed what was already observed worldwide with a predominance of poor adherence to treatment in patients with type 1 diabetes and a signifcant role of infection which concerned about 25% of the patients with DKA. Patients in all three groups had comparable blood glucose on admission. Although patients with type 1 diabetes received lower insulin doses than patients with type 2 or secondary diabetes and lower than those recommended in the UK guidelines, they had more episodes of hypoglycaemia (including profound hypoglycaemia). In contrast, patients with type 2 or secondary diabetes received an initial dose of insulin in accordance with the UK recommendations. This result suggests that, in our units, clinicians already considered the type of underlying diabetes in the management of DKA. In addition, it suggests that a decreased dose of insulin, either at its initiation or when glucose level decreased below a determined threshold as proposed by other authors, could help in preventing this frequent complication. Interestingly, a non-inferiority randomized controlled trial (RCT) comparing reduced dose of insulin (0.05 UI/ kg/h) with standard recommended dose (0.10 UI/kg/h) in children with DKA including almost exclusively patients with type 1 diabetes reported significantly less metabolic events in the group receiving the reduced dose of insulin, without altering the recovery time. It is reasonable to think that a similar effect would be observed in a DKA episode among adult patients with type 1 diabetes. The nationwide survey on the management of DKA in the UK by Dhatariya etal. did not differentiate patients by type of diabetes. Comparing our study populations at admission, it reveals that our patients were slightly more severe with higher blood glucose level (32 vs. 28.7 mmol/l) and lower bicarbonate concentration (6.5 vs. 11.3 mmol/l). In the study by Dhatariya etal., 27.6% of patients had at least one episode of hypoglycaemia during the first 24h. The threshold for diagnosing hypoglycaemia was not clearly indicated. In our study, 51.4 and 20.5% of patients had at least one episode of blood glucose lower than 4 and 2.9 mmol/l, respectively. Similarly, while Dhatariya etal. reported that 55% of patients developed an hypokalaemia during the first 24h, we observed that 63.3% of our patients presented at least one episode of serum potassium less than 3.5 mmol/l during the first 48h of management. Overall, it appears that the rate of metabolic events during DKA care remains high.
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