糖尿病酮癥酸中毒英文課件

1、糖尿病酮癥酸中毒英文糖尿病酮癥酸中毒英文糖尿病酮癥酸中毒英文case Mr wang，M，52 years oldchief complaint：polydipsia, polyuria, weakness for1week，vomiting for 10 hourphysical exam: tachypnea,BP 150/90mmHg,HR:120bpm,SaO2:99%ABG:PH:7.06,PaCO2:12mmHg,PaO2:117mmmHg,HCO3-:3.4mmol/L,Lactate:3.1mmol/L,BE:-24.7mmol/L，AG:34.6mmol/LBUN :15.9

2、mmol/L,Cr:147mmol/LK+:8mmol/L,Na+:118mmol/L,Cl-:80mmol/L,Glu:33mmol/Lurinalysis:ketone:3+,gravity:1.024,glu:4+2021/4/272糖尿病酮癥酸中毒英文糖尿病酮癥酸中毒英文糖尿病酮癥酸中毒英文case Mr wang，M，52 years oldchief complaint：polydipsia, polyuria, weakness for1week，vomiting for 10 hourphysical exam: tachypnea,BP 150/90mmHg,HR:120bp

3、m,SaO2:99%ABG:PH:7.06,PaCO2:12mmHg,PaO2:117mmmHg,HCO3-:3.4mmol/L,Lactate:3.1mmol/L,BE:-24.7mmol/L，AG:34.6mmol/LBUN :15.9mmol/L,Cr:147mmol/LK+:8mmol/L,Na+:118mmol/L,Cl-:80mmol/L,Glu:33mmol/Lurinalysis:ketone:3+,gravity:1.024,glu:4+2021/4/272case Mr wang，M，52 years old202problem what is the diagnosisw

4、hat is the reason of hyperkalemia and hyponatremiawhat is the reason of Metabolic acidosishow to dispose the disease if you are the ER doctor on call2021/4/273problem what is the diagnosis2 Introduction DKA is a syndrome in which insulin deficiency and glucagonexcess combine to produce a hyperglycem

5、ic, dehydrated,acidotic patient with profound electrolyte imbalance2021/4/274 Introduction DKA is a Pathophysiology2021/4/275Pathophysiology2021/4/275Pathophysiology2021/4/276Pathophysiology2021/4/276Pathophysiology Insulin deficiency and glucagon elevation results in hyperglycemia,which in turn cau

6、se glycosuria Glucose in the renal tubules draws water, sodium, potassium, magnesium, calcium, phosphorus, and other ions from the circulation into the urine This osmotic diuresis combined with poor intake and vomiting produces the profound dehydration and electrolyte imbalance associated with DKA A

7、s a result of acidosis and dehydration,however, the initial reported values for these electrolytes may be higher than actual body stores. 2021/4/277Pathophysiology Insulin dPathophysiology Insulin deficiency results in activation of lipase that increases circulating free fatty acid (FFA) levels. Lon

8、g-chain FFAs, now circulating in abundance as a result of insulin deficiency, are partially oxidized and converted in the liver to acetoacetate and -hydroxybutyrate. This alteration of liver metabolism to oxidize FFAs to ketones rather than the normal process of re-esterification to triglycerides ap

9、pears to correlate directly with the altered glucagon/insulin ratio in the portal blood.2021/4/278Pathophysiology Insulin dPathophysiology Glucagon is elevated fourfold to fivefold in DKA and is the most influential ketogenic hormone. Despite the increased pathologic glucagon-mediated production of

10、ketones, the body acts as it does in any form of starvation, to decrease the peripheral tissues use of ketones as fuel. The combination of increased ketone production with decreased ketone use leads to ketoacidosis. The acidosis cause the body to increase lung ventilation and rid the body of excess

11、acid with Kussmauls respiration2021/4/279Pathophysiology 2021/4/279Etiology DKA may be caused by cessation of insulin intake or by physical or emotional stress despite continued insulin therapy. Most often, DKA occurs in patients with type 1 diabetes and is associated with inadequate administration

12、of insulin, infection,or myocardial infarction (MI). DKA can also occur in type 2 patients and may be associated with any type of stress, such as sepsis or gastrointestinal (GI) bleeding2021/4/2710Etiology DKA may be cDiagnostic Strategies History Clinically, most patients with DKA complain of a rec

13、ent history of polydipsia, polyuria, polyphagia, visual blurring, weakness,weight loss, nausea, vomiting, and abdominal pain. 2021/4/2711Diagnostic Strategies History2Diagnostic StrategiesPhysical Examination Typical findings include tachypnea with Kussmauls respiration, tachycardia, frank hypotensi

14、on , the odor of acetone on the breath, and signs of dehydration2021/4/2712Diagnostic StrategiesPhysical Diagnostic StrategiesLaboratory Tests On the patients arrival to the ED, serum and urine glucose and ketones, electrolytes, and arterial blood gases (ABGs) should be checked. Glucose is usually e

15、levated above 350 mg/dL; however, euglycemic DKA (blood glucose 200 mg/dL), ketonemia ,acidemia (pH 7.3). DKA can be caused by any condition that reduces insulin availability or activity or that increases glucagon. Precipitating events usually include infections, surgery, and emotional orphysical st

16、ressors. Treatment is aimed at fluid replacement over the first 24 to 48 hours, insulin replacement, and potassium replacement.2021/4/2728 Summary Diabetic Ketoacikeywhat is the diagnosis DKAwhat is the reason of hyperkalemia and hyponatremia As a result of acidosis and dehydration,however, the init

17、ial reported values for potassium may be higher than actual body stores. Sodium is often low in the presence of significant dehydration because it is strongly affected by hyperglycemia; hypertriglyceridemia;salt-poor fluid intake; and increased GI, renal, and insensible losseswhat is the reason of Metabolic acidosis Metabolic acidosis with an anion gap is primarily the result of elevated plasma levels of acetoacetate and -hy