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Diabetic Ketoacidosis

内分泌

关键词内分泌 临床研究术语 糖尿病

词汇介绍

拓展阅读

解析

diabetic   英 /daɪə'betɪk/   美 /,daɪə'bɛtɪk/

       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

       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/

       n. [内科] 酮酸中毒;酮病

同根词   ketosis n. [内科] 酮病

       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

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

Initial management of diabetic ketoacidosis and prognosis according to diabetes type: a French multicentre observational retrospective study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

影响因子: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.

译文

DKA的沉淀原因引起了全世界已经观察到的症状,其中1型糖尿病患者对治疗的依从性较差,并且感染的重要作用涉及25%的DKA患者。所有三组患者入院时血糖均相当。尽管1型糖尿病患者的胰岛素剂量低于2型或2型糖尿病患者,且低于英国指南推荐的患者,但他们有更多的低血糖发作(包括严重的低血糖)。相反,根据英国的建议,2型或2型糖尿病患者接受初始剂量的胰岛素治疗。这一结果表明,在我们的单位中,临床医生已经考虑了DKA管理中潜在糖尿病的类型。此外,它表明胰岛素的剂量减少,无论是在其开始时还是在葡萄糖水平降低到其他作者提出的确定阈值以下时,都可以帮助预防这种常见的并发症。有趣的是,一项非劣效性随机对照试验(RCT)比较了降低剂量的胰岛素(0.05 UI / kg / h)与标准推荐剂量(0.10 UI / kg / h)的DKA患儿,包括几乎全部患有1型糖尿病的患者在不改变恢复时间的情况下,接受减少剂量的胰岛素的组中的代谢事件显着减少。可以合理地认为在成人1型糖尿病患者的DKA发作中会观察到类似的效果。 Dhatariya等人在英国进行的关于DKA管理的全国性调查。没有根据糖尿病的类型区分患者。比较我们入院时的研究人群,结果显示我们的患者血糖水平较高(32对28.7 mmol / l)和碳酸氢盐浓度较低(6.5对11.3 mmol / l)稍微严重一些。在Dhatariya等人的研究中,27.6%的患者在最初的24小时内至少有一次低血糖发作。没有明确指出诊断低血糖的阈值。在我们的研究中,51.4%和20.5%的患者至少有一次血糖低于4和2.9 mmol / l。同样,Dhatariya等人。据报道,55%的患者在最初的24小时内出现了低钾血症,我们观察到63.3%的患者在治疗的前48小时内至少出现了一次血清钾低于3.5 mmol / l的情况。总体而言,似乎DKA护理期间的代谢事件发生率仍然很高。