2型糖尿病酮症酸中毒43例的预见性护理

目的探讨预见性护理在预防糖尿病酮症酸中毒中的作用。方法在分析糖尿病患者的临床特点及酮症酸中毒诱因的基础上对观察组实施预见性护理；随机抽取前期同类病例作为对照组。结果观察组的病死率、酮症酸中毒发生率均低于对照组，有显著性差异，P〈0．01。结论预见性护理可及时发现并消除糖尿病酮症酸中毒的诱因及潜在危险因素，降低酮症酸中毒发生率、糖尿病的病死率。     

1例2型糖尿病酮症酸中毒病人的抢救护理

糖尿病酮症酸中毒是糖尿病最常见的急性并发症,病死率为5%～10%,老年糖尿病患酮症酸中毒的病死率达50%,而酮症酸中毒主要是由于体内胰岛素缺乏引起的高血糖、高血酮和代谢酸中毒为主要改变的临床综合征,以发病急、病情重、变化快为特点。2011年12月20日我科收治1例糖尿病酮症酸中毒的病人,经抢救治疗、护理,病人痊愈出院。现将护理总结如     

糖尿病酮症酸中毒昏迷的抢救护理

糖尿病酮症酸中毒(简称ＤＫＡ)是糖尿病最严重的并发症之一,多发生在胰岛素依赖型病人,其诱因有:感染、胰岛素治疗中断或不适当减量,饮食不当、创伤、手术、妊娠和分娩等,有时无明显诱因。由于体内胰岛素相对或绝对不足,靶细胞对胰岛素不敏感引起高血糖,高血酮的一组临床综合征。自1998年12月～1999年1月我科成功抢救了6例糖尿病酮症酸中毒昏迷患者,良好护理是治疗酮症酸中毒的一个重要环节,现将护理体会报告如下。1　临床资料6例糖尿病酮症酸中毒患者中男性3例,女性3例;非胰岛素依赖型糖尿病2例,胰岛素依赖型糖尿病4例;年龄24～52岁;发病诱…     

糖尿病酮症酸中毒30例护理分析

目的:总结糖尿病酮症酸中毒的护理体会.方法:回顾性分析2008年6月至2011年6月收治的30例糖尿病酮症酸中毒的临床护理资料.结果:30例中治愈29例,死亡1例,死于大面积脑梗死.结论:及时去除糖尿病酮症酸中毒的诱因和采取胰岛素、液体复苏和细致护理等综合措施可提高糖尿病酮症酸中毒的治愈率,加强对糖尿病患者的宣教对预防糖尿病酮症酸中毒的发生至关重要.     

糖尿病酮症酸中毒的临床救治研究进展

由于近年来我国糖尿病发病人数的大量增长以及糖尿病规范治疗的依从性差、血糖控制达标率低,糖尿病酮症酸中毒(DKA)已成为临床急诊科的常见病。临床上本病以发病急、病情危重、进展迅速为特点,其治疗应以消除诱因、扩容、补充小剂量胰岛素、纠正电解质紊乱等综合治疗措施为主。本文整理了目前糖尿病酮症酸中毒的临床治疗进展,结合自身的工作体会做一综述。     

69例糖尿病酮症酸中毒临床分析

对６９例糖尿病酮症酸中毒患者进行了回顾性分析,探讨其诱发因素、临床表现及预后。结果：引起糖病酮症酸中毒诱因中感染占首位,其次为医源诱因及停用降糖药。临床表现以消化道平主,其次为原有糖尿病症状加重及脱水表现。医源诱因组中急性肾功能衰竭发生率及酮症酸中毒病死率高,预后差,值得高度重视。     

通便导泻疗法在糖尿病酮症酸中毒患者中的应用

糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)是糖尿病急性并发症,也是内科常见急症之一,病死率约为5%,在老年人中可达43%。发病后除规范的胰岛素注射、补钾、补液等治疗外,良好的护理也是抢救成功的关键[1]。本研究对我科2000年3月-2005年2月收治的46例糖尿病酮症酸中毒患者的资料进行分析,旨在探讨在综合管理的基础上,应用通便导泻疗法对糖尿病酮症酸中毒患者的临床治疗价值,现报道如下。资料与方法1.一般资料。46例糖尿病酮症酸中毒患者,年龄49~81岁,平均年龄(68.8±8.9)岁。糖尿病病史3.6~24.6年,平均7.3年。发病诱因为感染28例占60.…     

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。     

老年糖尿病酮症酸中毒42例临床特点及护理

总结42例老年糖尿病酮症酸中毒患者临床特点及护理措施。老年糖尿病酮症酸中毒临床特点为诱因隐匿多变且发病症状体征不典型,发病症状多样且常与其他病变相混淆,合并慢性病变且多种疾病并存。护理上全面把握老年糖尿病酮症酸中毒的临床特点,严密观察病情,加强基础护理,做好心理护理与健康指导。经抢救和护理,1例因合并高渗性昏迷、呼吸衰竭死亡,41例患者尿酮消失,血糖控制在8.5mmol/L左右,均病情好转出院,抢救成功率为97.62%。     

糖尿病酮症酸中毒36例诱因分析及对策

目的:探讨糖尿病患者发生酮疰酸中毒的诱因并制定相关护理对策.方法:选择36例糖尿病酮症酸中毒患者,对其诱因进行回顾性调查分析,并提出个体化护理对策.结果:36例糖尿病患者发生酮症酸中毒诱因较高为感染因素19例(52.8％),停用胰岛素5例(13.9％),用药不规则和饮食不当各3例(8.4％);经抢救后本组患者治愈率为94.4％.结论:针对糖尿病患者发生酮症酸中毒的不同诱因,给予综合治疗和护理的同时,应加强基础护理、健康教育,以提高患者自我护理能力.     

Important Dietary Considerations for Sodium-Glucose Cotransporter 2 Inhibitors

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a pharmacologic option for type 2 diabetes, and several benefits beyond glycemic lowering, including cardiovascular and renal, are associated with their use. However, some rare but serious potential adverse effects have been reported, including diabetic ketoacidosis (DKA) and euglycemic DKA. Certain dietary factors may increase the risk of SGLT2 inhibitor–associated ketoacidosis, such as low-carbohydrate and ketogenic diets, prolonged fasting, dehydration, and excess alcohol consumption. Clinicians should remain cognizant of precipitating factors; discuss modifiable risk factors with patients; and implement preventive strategies, such as withholding a SGLT2 inhibitor in situations associated with risk.     

老年糖尿病酮症酸中毒患者甲状腺激素水平变化研究

目的探讨老年糖尿病酮症酸中毒（DKA）患者甲状腺激素水平变化,为该类疾病患者的临床治疗提供依据。方法选择老年2型糖尿病患者共175例,分为DKA患者81例（DKA组）和无严重并发症的2型糖尿病患者94例（对照组）。检测两组治疗前后的血清甲状腺激素水平变化并分析。结果治疗前DKA组总三碘甲状腺氨酸（TT3）、总甲状腺素（TT4）、游离三碘甲状腺原氨酸（n）均显著低于对照组,两组游离四碘甲状腺原氨酸（FT3）、促甲状腺素（TSH）比较无统计学差异。DKA组治疗后m、Tr4、Fr4均显著升高,与治疗前相比有统计学差异,FT3和TSH较治疗前无显著差异。DKA组治疗后血清甲状腺激素水平与对照组治疗后相比无统计学差异。结论老年糖尿病合并DKA的患者可出现甲状腺激素水平降低,但常规治疗后恢复,因此应综合考虑,不可盲目加用甲状腺激素进行治疗。     

Diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is a form of a hyperglycemic emergency mainly characterized by the triad of hyperglycemia, ketosis, and anion gap metabolic acidosis. DKA may be the initial presentation in approximately 25-40 % of patients with type 1 diabetes. It may also occur in at least 34% of patients with type 2 diabetes. DKA has economic as well as medical implications. This review aims to explore and discuss diabetic ketoacidosis, its pathophysiology, clinical presentation, diagnosis, and management, including nuances in special populations such as pediatrics, obstetrics, and patients with chronic kidney disease.     

Treatment of diabetic ketoacidosis with subcutaneous insulin aspart

OBJECTIVE: In this prospective, randomized, open trial, we compared the efficacy and safety of aspart insulin given subcutaneously at different time intervals to a standard low-dose intravenous (IV) infusion protocol of regular insulin in patients with uncomplicated diabetic ketoacidosis (DKA). RESEARCH DESIGN AND METHODS: A total of 45 consecutive patients admitted with DKA were randomly assigned to receive subcutaneous (SC) aspart insulin every hour (SC-1h, n = 15) or every 2 h (SC-2h, n = 15) or to receive IV infusion of regular insulin (n = 15). Response to medical therapy was evaluated by assessing the duration of treatment until resolution of hyperglycemia and ketoacidosis. Additional end points included total length of hospitalization, amount of insulin administration until resolution of hyperglycemia and ketoacidosis, and number of hypoglycemic events. RESULTS: Admission biochemical parameters in patients treated with SC-1h (glucose: 44 +/- 21 mmol/l [means +/- SD], bicarbonate: 7.1 +/- 3 mmol/l, pH: 7.14 +/- 0.09) were similar to those treated with SC-2h (glucose: 42 +/- 21 mmol/l, bicarbonate: 7.6 +/- 4 mmol/l, pH: 7.15 +/- 0.12) and IV regular insulin (glucose: 40 +/- 13 mmol/l, bicarbonate 7.1 +/- 4 mmol/l, pH: 7.11 +/- 0.17). There were no statistical differences in the mean duration of treatment until correction of hyperglycemia (6.9 +/- 4, 6.1 +/- 4, and 7.1 +/- 5 h) or until resolution of ketoacidosis (10 +/- 3, 10.7 +/- 3, and 11 +/- 3 h) among patients treated with SC-1h and SC-2h or with IV insulin, respectively (NS). There was no mortality and no differences in the length of hospital stay, total amount of insulin administration until resolution of hyperglycemia or ketoacidosis, or the number of hypoglycemic events among treatment groups. CONCLUSIONS: Our results indicate that the use of subcutaneous insulin aspart every 1 or 2 h represents a safe and effective alternative to the use of intravenous regular insulin in the management of patients with uncomplicated DKA.     

Updates in the Management of Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is an emergency for people with diabetes characterized by hyperglycemia, metabolic acidosis, and ketosis. DKA onset and recurrence can largely be prevented through patient education. Nurse practitioners are well positioned to promote patient education, self-management, and individualized patient care. This article outlines updates in the clinical management of patients with DKA to optimize care and reduce costs.     

Differences in metabolic and hormonal milieu in diabetic- and alcohol-induced ketoacidosis

PURPOSE: Diabetic ketoacidosis (DKA) and alcoholic ketoacidosis (AKA) are two medical emergencies characterized by elevated total ketone body concentration. We aimed to determine differences in pathogenesis of ketoacidosis and its metabolic consequences by comparing both at presentation and during treatment, the different metabolic products and hormones involved in the ketoacidotic state. MATERIALS AND METHODS: We studied 12 patients with DKA and 8 patients with AKA. On admission and every 4 hours for 24 hours during treatment, samples were drawn for determination of serum ketone bodies, lactate and pyruvate, insulin, and counterregulatory hormones (glucagon, cortisol, growth hormone, and catecholamines). RESULTS: At presentation, with a similar beta-hydroxybutyrate concentration, patients with DKA had a higher plasma glucose (32 mmol/L vs. 6.6 mmol/L), lower beta-hydroxybutyrate/acetoacetate ratio (3:1 vs. 7:1), and a lower lactate/pyruvate ratio (11:1 vs. 19:1) than patients with AKA (all, P < .01). The mean time to resolve ketoacidosis in patients with AKA (6 +/- 1 hour) was significantly shorter than in patients with DKA (16 +/- 2 hours). At presentation, the mean insulin concentration in patients with DKA and AKA were similarly decreased (7.8 +/- 2 and 10.3 +/- 3 microU/mL, P = not significant [NS]).The mean glucagon level before therapy was 203 +/- 15 pg/mL and 188 +/- pg/mL for patients with DKA and AKA, respectively (P = NS). Levels of cortisol, growth hormone, and epinephrine at presentation and during the first 8 hours of treatment were higher in patients with DKA; however, the difference in these values did not reach statistical significance. During therapy, levels of counterregulatory hormones declined at similar rates and returned to normal values after resolution of ketoacidosis. CONCLUSIONS: Our results indicate that, in addition to a history of diabetes or alcoholism, patients with DKA and AKA differ in their metabolic parameters more than in their hormonal profile. The metabolic profile of DKA is characterized by a higher plasma glucose concentration, and lower beta-hydroxybutyrate to acetoacetate and lactate to pyruvate ratios compared with patients with AKA. The initial hormonal profile in both ketoacidotic states is characterized by similarly decreased insulin levels and elevated levels of counterregulatory hormones.     

Cognitive Abilities in a Sample of Youth with Multiple Episodes of Diabetic Ketoacidosis

Noncompliance with medical regimens for type 1 diabetes (T1D) may lead to serious consequences. The most life-threatening is diabetic ketoacidosis (DKA). Little is known about how DKA affects cognitive abilities in youth with T1D. We examined the impact of multiple DKA episodes and gender differences on cognitive abilities. Sixty-four youth (aged 8–16) who experienced at least two DKA episodes participated. Participants had lower index and subtest scores relative to norms. Gender differences on index scores were found with boys scoring higher. Results suggest DKA episodes may impact cognitive abilities. Researchers should continue to examine the link between DKA and intellectual ability.     

目标降糖策略在难治性糖尿病酮症酸中毒的应用

目的探讨糖尿病酮症酸中毒（DKA）的治疗方法。方法经常规治疗无效的DKA患者36例，采取目标降糖策略，给予强化胰岛素治疗和奥曲肽治疗。结果治愈率83．3％（30／36），病死率16．7％（6／36）。血糖控制与低血压、低氧血症纠正呈明显负相关。血糖控制与高渗血症、酸中毒纠正呈明显正相关。结论目标降糖策略是DKA的有效治疗方法。     

Diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes characterized by hyperglycemia, ketosis and acidosis. The pathophysiology of DKA is reviewed and diagnostic and therapeutic modalities are discussed in the context of the currently available evidence. Complications associated with DKA are often a result of the treatment itself, and these issues are also discussed.     

Treatment practices of diabetic ketoacidosis at a large teaching hospital

A retrospective chart review of 55 medical records of adults treated for diabetic ketoacidosis (DKA) identified areas of treatment that delayed the improvement of DKA. There was a positive correlation between time to initiation of insulin infusion and resolution of anion gap. Sixty-six percent of cases did not have the recommended overlap between intravenous and subcutaneous insulin. Opportunity exists to educate nurses as experts to partner with their physician colleagues to manage DKA.