经胃肠道补液联合静脉补液治疗糖尿病酮症、酮症酸中毒、高渗昏迷的临床观察

目的探讨通过胃肠道补液联合静脉补液治疗糖尿病并发酮症、酮症酸中毒或高渗的有效性。方法在应用胰岛素的同时足量的胃肠道补液,每日补液量2 000~6 000 mL,辅以静脉输液每日500~2 000 mL,持续7 d。观察尿量、血气分析、血糖、尿酮及血钠的变化。结果 32例患者的相关指标均得到明显改善以至痊愈。结论经胃肠道补液,是治疗糖尿病并发酮症、酮症酸中毒和高渗的有效方法。     

抢救小儿糖尿病酮症酸中毒的输液管理

本文总结了50例小儿糖尿病酮症酸中毒的输液管理经验,认为准确控制胰岛素输入速度和输入量,掌握补液原则,正确补充碱性药物和电解质是护理的关系。     

糖尿病酮症酸中毒病人的紧急评估与急救护理

[目的]探讨急诊糖尿病酮症酸中毒病人的紧急评估与急救护理。[方法]对29例急诊糖尿病酮症酸中毒病人进行紧急评估,采取急救措施,合理补液、胰岛素治疗、纠正电解质、酸碱平衡紊乱,严密观察病情变化,做好心理护理、健康教育等措施。[结果]29例糖尿病酮症酸中毒病人经过积极的抢救病情好转,血糖趋于稳定。其中1例因严重感染合并重要脏器功能衰竭,经抢救无效而死亡。[结论]通过对急诊糖尿病酮症酸中毒病人进行紧急评估,积极的治疗与护理是有效的。     

胃肠道补液及胰岛素微泵输入在2型糖尿病酮症酸中毒抢救中的应用

目的；探讨胃肠道补液及胰岛素微泵输入在2型糖尿病酮症酸中毒抢救中的效果。方法：对我院42例2型糖尿病酮症酸中毒在诊断及治疗等方面作一回顾性分析。结果：2型糖尿病酮症酸中毒在各种诱因的作用下临床表现不一．经予以胃肠道补液及胰岛素微泵输入治疗后，治愈和好转39例，有效率93%。结论：胃肠道补液及小剂量胰岛素的合理应用．是目前抢救2型糖尿病酮症酸中毒最安全有效的方法。     

胃肠道补液联合静脉补液在治疗老年性糖尿病酮症酸中毒中的护理

目的提高老年性糖尿病酮症酸中毒的救治成功率,预防并发症。方法总结26例老年性糖尿病酮症酸中毒患者选择胃肠道补液为主、静脉补液为辅的治疗方法,给予系统的病情观察与护理。结果26例老年性糖尿病酮症酸中毒患者均痊愈出院。结论补液治疗中系统的病情观察与护理,是提高救治成功率的关键。     

2型糖尿病酮症酸中毒63例分析

目的：总结分析2型糖尿病酮症酸中毒的临床诊治要点,提高治愈率,降低死亡率。方法：对63例2型糖尿病酮症酸中毒患者进行回顾性分析。结果：63例2型糖尿病酮症酸中毒患者全部抢救治疗成功。结论：足量补液、小剂量胰岛素应用、纠正电解质酸碱平衡失调、去除诱因和治疗并发症的综合治疗方法是糖尿病酮症酸中毒治疗成功的关键。     

糖尿病酮症酸中毒的抢救护理32例

对32例糖尿病酮症酸中毒患者的抢救护理实行回顾性总结.酮症酸中毒救治的关键在早期诊断、大量快速补液、彻底纠正酸中毒和控制血糖,通过积极的治疗与精心的护理,32例患者均痊愈出院.     

糖尿病酮症酸中毒病人使用留置针后封管方法的探讨

[目的]探讨糖尿病酮症酸中毒病人使用留置针后的封管方法。[方法]对30例糖尿病酮症酸中毒病人行留置针穿刺,封管后各6 h、12 h再输液。[结果]糖尿病酮症酸中毒病人封管后≥12 h连接输液的均出现堵管,封管后≤6 h连接输液的均通畅。[结论]糖尿病酮症酸中毒病人使用留置针封管后每隔6 h封管1次可保证下次输液通畅。     

胃肠内补液联合静脉补液治疗糖尿病酮症酸中毒

目的：探讨胃肠内补液联合静脉补液对糖尿病酮症酸中毒（DKA）的疗效。方法：将120例DKA患者随机分为两组，治疗组60例采用胃肠内补液联合静脉补液治疗，对照组60例采用单纯性静脉补液治疗，观察两组患者治疗前后血生化及尿酮体消失时间等指标的变化。结果：治疗组治疗24h后的血糖、血钾、血钠均较治疗前明显下降（P＜0．05）；与对照组相比，治疗组的电解质及二氧化碳结合力恢复正常的时间较快，尿酮体消失早，昏迷患者清醒早，静脉补液量少，无一例发生脑水肿，肺水肿和低血钾等并发症。结论：对DKA患者除采用静脉输液外，加用胃肠内补液更简便易行，安全有效。     

糖尿病酮症酸中毒临床治疗体会

探讨糖尿病酮症酸中毒的临床治疗效果。以56例糖尿病酮症酸中毒患者为研究对象,对相关指标进行实验室检查,采取补液、静脉滴注胰岛素、处理电解质紊乱及酸中毒等措施,对患者进行治疗。患者经胰岛素静脉滴注、补液等多种措施治疗后,50例好转,12h内血糖降至14mmol/L左右,临床症状得到改善,酮体4d内消失,治疗总有效率为89.29%;死亡5例,主要原因是严重感染3例,心衰休克2例。糖尿病酮症酸中毒患者需要早期发现,及时救治,提高患者的治愈率,挽救患者生命。     

Diabetic ketoacidosis in a community-based population

Ninety-two cases of diabetic ketoacidosis were identified in residents of Rochester, Minnesota, over a 52-year period; 42% occurred in patients with juvenile-onset diabetes. The most common cause of diabetic ketoacidosis was infection. In 23% of the patients, diabetic ketoacidosis was the initial manifestation of diabetes mellitus. The frequency of retinopathy, neuropathy, and glomerulosclerosis was significantly increased in the surviving diabetic patients with ketoacidosis in comparison with diabetic patients matched for age and sex who did not experience ketoacidosis. Seven deaths occurred in the first 24 hours of diagnosis of ketoacidosis, but only one could be attributed to ketoacidosis alone. An additional six patients died within 48 hours of the recognition of ketoacidosis. The major cause of all deaths occurring within 48 hours of hospitalization for ketoacidosis was myocardial infarction.     

Management of diabetic ketoacidosis.

Diabetic ketoacidosis is an emergency medical condition that can be life-threatening if not treated properly. The incidence of this condition may be increasing, and a 1 to 2 percent mortality rate has stubbornly persisted since the 1970s. Diabetic ketoacidosis occurs most often in patients with type 1 diabetes (formerly called insulin-dependent diabetes mellitus); however, its occurrence in patients with type 2 diabetes (formerly called non-insulin-dependent diabetes mellitus), particularly obese black patients, is not as rare as was once thought. The management of patients with diabetic ketoacidosis includes obtaining a thorough but rapid history and performing a physical examination in an attempt to identify possible precipitating factors. The major treatment of this condition is initial rehydration (using isotonic saline) with subsequent potassium replacement and low-dose insulin therapy. The use of bicarbonate is not recommended in most patients. Cerebral edema, one of the most dire complications of diabetic ketoacidosis, occurs more commonly in children and adolescents than in adults. Continuous follow-up of patients using treatment algorithms and flow sheets can help to minimize adverse outcomes. Preventive measures include patient education and instructions for the patient to contact the physician early during an illness.     

Fluid management in children with diabetic ketoacidosis

QuestionPrevious research has indicated that rapid rehydration in children with type 1 diabetes who present with diabetic ketoacidosis could result in cerebral edema. I have been treating patients with diabetic ketoacidosis with gradual fluid replacement. With the risk of cerebral injury in these patients, should I continue management with slow fluid rehydration?AnswerRecent research has shown that neither fluid infusion rate nor sodium chloride concentration increases risk of cerebral injury. However, it is possible for subtle brain injury to occur during treatment, regardless of the fluid administration strategy. The 2018 International Society for Pediatric and Adolescent Diabetes guidelines have been updated in light of this research.     

Fluid resuscitation in children

Children most often need fluid resuscitation because of fluid loss (especially from diarrhoea), while bleeding and sepsis account for a minority of cases. The child's immature body systems (especially cardiovascular and renal), age-dependent fluid compartment sizes and lack of degenerative vascular diseases of adulthood affect the child's clinical signs and the response to hypovolaemia and to resuscitation. The issues of what fluid, how much, how fast and by what route are interdependent. In general, aggressive early fluid resuscitation reduces mortality and morbidity in children with burns and sepsis, while slow rehydration over 48 hours is safer in dehydrated children with diarrhoea or diabetic ketoacidosis. There are few specifically paediatric data comparing hyper- or isotonic crystalloid with colloid, or the various colloids with each other, so that legends abound in paediatric resuscitation. The empirical basis of these legends will be discussed in this paper. Safe resuscitation requires close observation of the cardiovascular system, conscious state, urine output and blood chemistry. When close biochemical monitoring is not possible, a fluid regime should be chosen which is least likely to cause biochemical changes.     

批量烧伤伤员早期休克补液公式的选择

目的探讨批量烧伤伤员早期快速补液的最佳方法。方法将实际补液量与运用南京烧伤补液和第三军医大学烧伤补液公式进行比较,探索适于批量伤员快速补液的最佳方法。结果南京烧伤补液公式与第三军医大学烧伤补液公式采集指标时间及计算时间比较,差异均有统计学意义(t1=-61.123,P<0.01;t2=4.293,P<0.01)。8h实际补液量与南京烧伤补液公式理论补液量、第三军医大学烧伤补液公式理论补液量之间的差异无统计学意义(P>0.05)。经t检验,对不同性别,采用南京烧伤补液、第三军医大学烧伤补液公式计算的1%烧伤面积补液量的差异无统计学差异(P>0.05)。结论南京烧伤补液公式是适用基层单位早期救治成批烧伤休克补液优先选择方案,同时应注意个性化治疗方案。     

Comparison of Three Oral Rehydration Strategies in the Treatment of Acute Diarrhea in a Tropical Country

Background: The administration of hydrating solutions and early refeeding improve recovery for infants and children with diarrhea.Objective: The aim of this study was to assess the efficacy of a low-osmolarity (30 mEq/L Na⁺) solution administered after the standard, high-osmolarity (90 mEq/L Na⁺) solution via a nasogastric tube (NGT) and followed by early refeeding to achieve more rapid body weight recovery in infants and children with acute diarrhea.Methods: Infants and children aged <5 years with acute diarrhea and dehydration (body weight loss of ≥10%) observed from January to August 2001 at Saint Camille Medical Center, Ouagadougou, Burkina Faso, were enrolled. Patients were randomized to 1 of 3 treatment protocols. Patients in group A received, via NGT, rehydration with a high-osmolarity solution for 3 hours, followed by a low-osmolarity solution for at least 3 additional hours. Patients in group B were given only a low-osmolarity solution via NGT. In group C, rehydration was carried out using a high-osmolarity solution via NGT.Results: Four thousand consecutively treated infants and children (2010 boys, 1990 girls; mean [SD] age, 3.5 [2.7] years) were enrolled. After the first 6 hours of infusion, 90% of the patients who had received the combined rehydration (group A) showed significant body weight recovery, versus 80% and 79% of the patients in groups B and C, respectively. Stool output significantly decreased for group A compared with groups B and C (114 vs 125 and 120 g/kg, respectively). Only 7% of the patients in group A required prolonged rehydration (>6 hours) with the low-osmolarity solution, versus 10% and 12% in groups B and C, respectively. A total of 3% of patients treated with combined rehydration required hospitalization, compared with 10% and 9% in groups B and C, respectively. At the end of infusion, 25% of the patients rehydrated only with a low-osmolarity solution showed poor body weight recovery and appeared lethargic, versus 10% in group A and 15% in group C. Patients who were rehydrated with a high-osmolarity solution showed symptoms of hypernatremia (serum Na⁺ concentration >140 mEq/L). At the end of rehydration (≥6 hours), all patients recovered their previous body weight, partially or totally, and refeeding was begun. Rehydration and diet were continued at home, or in neighboring areas for those living far away.Conclusions: In this study population, the administration of a high-osmolarity solution followed by a low-osmolarity solution and early refeeding was effective in the treatment of acute diarrhea and was well tolerated.     

Hypernatremia in the elderly

Hypernatremia is common in elderly persons, who may present with signs that are easily overlooked. Prompt diagnosis and appropriate therapy can sometimes lead to a remarkable recovery. To avoid cerebral edema, rehydration must be accomplished gradually over 48 to 72 hours. The recommended replacement for the first 24 hours is approximately 30 percent of the estimated water loss.     

Diabetic emergencies.

Diabetic emergencies include diabetic ketoacidosis, insulin-induced hypoglycemia, hyperosmolar coma and lactic acidosis. By determining the blood pressure, observing for evidence of dehydration or sweating and making a rapid qualitative assessment of blood glucose and ketonemia, the physician can usually identify the condition promptly. When adequate facilities are available, continuous intravenous insulin infusion is preferred for treatment of diabetic ketoacidosis. The nonketotic hyperosmolar state should be corrected gradually, not rapidly, in order to avoid cerebral edema.     

Hypophosphatemia and acute respiratory failure in a diabetic patient

A previously healthy 48-year-old male developed diabetic ketoacidosis and severe hypophosphatemia. Within a few hours, acute respiratory insufficiency developed with a marked discrepancy between the pulmonary pathology and the very poor oxygenation seen. We argue that this was due to the effect of hypophosphatemia on respiratory muscle- and heart function and P₅₀, leading to impaired oxygen delivery.     

?dème cérébral aigu au cours de l’acidocétose diabétique de l’enfant

Diabetic ketoacidosis is the most common cause of morbidity and mortality in children with type I diabetes mellitus. The main cause of pediatric death is cerebral edema responsible for intracranial hypertension. This cerebral edema appears in approximately 1% of ketoacidosis, mostly in the first 24 hours of management. Even if the pathophysiology remains unclear, some risk factors have been identified, principally due to the preexistent conditions, but also to iatrogenic events. Improvement in epidemiologic, pathophysiologic and clinical knowledge has resulted in great progress in the management of ketoacidosis, thus reducing morbidity and mortality in the most recent series. Intracranial hypertension can be responsible for major brain impairment; however, most of the time, cerebral edema is subclinical. This highlights the importance of a systematic research for detecting primary signs of cerebral edema in all patients presenting ketoacidosis in order to improve their management. We will review the principal aspects of management of pediatric ketoacidosis regarding diagnosis (clinical and radiological with the development of transcranial doppler) and treatments. The best guaranty to obtain a significant reduction in morbidity and mortality depends on the early recognition of type I diabetes mellitus, before ketoacidosis, which could be considered as a public health objective, which has already been reached in several countries.