糖尿病酮症酸中毒并乳酸酸中毒的救治体会

目的:通过分析2型糖尿病患者酮症酸中毒并乳酸酸中毒的临床表现,提高对疾病的认识,初步探讨其发病机制及诊治方法。方法:总结12例糖尿病酮症酸中毒合并乳酸酸中毒的临床资料并进行具体分析。结果:12例病例通过祛除诱因、补液、控制血糖、抗感染以及纠正电解质紊乱后病情好转并出院。结论:对糖尿病酮症酸中毒合并乳酸性酸中毒的患者在诊治过程中如无条件行持续静脉-静脉血液滤过,按照酮症酸中毒治疗原则进行治疗亦可以提高抢救成功率。     

Renal tubular acidosis in chronic liver disease

Renal tubular acidosis of the gradient or classic type, thought to be due to a disorder of the distal tubule, has been found to occur in 32% of 117 patients with chronic liver disease. Whilst the cause of this disorder is probably multifactorial, immunological mechanisms are considered to play a major role. The presence of this disorder might well be a cause, rather than the result of, the various electrolyte abnormalities seen in patients with chronic liver disease.     

Low- and high-dose intravenous insulin therapy for diabetic ketoacidosis.

We compared low-dose, continuous insulin infusion with a conventional high-dose intravenous bolus method of insulin administration in 18 episodes of diabetic ketoacidosis. The average rate of reduction in serum glucose concentration was 9.5 +/- 3.8%/hr in the continuous infusion group and 10.7 +/- 4.7%/hr in the bolus group. Arterial blood pH was corrected to 7.35 by 9.9 +/- 2.6/hours in the continuous infusion group and by 10.4 +/- 3.2/hours in the bolus group. The above means are not significantly different between groups. By the time pH was corrected to 7.35, patients in the continuous infusion group had received 121 +/- 44 units of insulin, whereas those in the bolus group had received 326 +/- 152 units. The continuous low-dose insulin infusion method is as safe and efficacious as the conventional high-dose intravenous bolus method.     

酸中毒起病方式对酮症酸中毒的影响

【摘要】目的 提高临床医师对酮症酸中毒起病患者酸中毒的认识。方法 选择2003年~2013年在广西医科大学附属第九人民医院北海市人民医院住院治疗的187例糖尿病酮症酸中毒患者的临床资料,根据是否酮症酸中毒起病,分为122例非酮症酸中毒起病患者和75例酮症酸中毒起病患者两组。然后将两组分为1型糖尿病组和2型糖尿病组,比较各组的年龄、血糖、血钠、血钾、糖化血红蛋白、PH值。结果 在不考虑酮症酸中毒的糖尿病分型的时候,以酮症酸中毒起病的糖尿病患者的年龄、糖化血红蛋白都低于非酮症酸中毒起病的糖尿病患者。当只将非酮症酸中毒起病的组分为1型糖尿病组和2型糖尿病组后,非酮症酸中毒起病的1型糖尿病的PH值比2型糖尿病组低。当酮症酸中毒起病组和非酮症酸中毒起病的组都分为1型糖尿病组和2型糖尿病组后,DKA起病的2型糖尿病组的血钠正常,而其他3组都具有轻度低钠。结论 临床医师应重视1型糖尿病引起的酮症酸中毒的严重性;对于酮症酸中毒起病的患者,血钠可作为初步区分2型糖尿病酮症酸中毒起病患者的指标。     

Prevention of diabetic ketoacidosis.

Absolute deficiency of insulin no longer is considered the principal cause of ketoacidosis. A combination of pathogenic mechanisms includes (1) relative insulin deficiency, (2) stress hormone excess, (3) fasting, and (4) dehydration. Prevention of any one or more of these mechanisms will reverse or lessen the rate of metabolic decompensation. Several important metabolic parameters must be monitored at frequent intervals to permit rational, preventive therapy. The flow sheet to be maintained by the patient should include body weight, temperature, respiratory rate, level of consciousness, degree of ketonuria, and degree of glycosuria. If the patient exhibits decreased mental status, more than 5% loss of body weight, or respirations more than 36/min, hospitalization is indicated.     

Type IV renal tubular acidosis and spironolactone therapy in the elderly.

Spironolactone therapy is a well-known cause of hyperkalaemia, but in susceptible patient, it may also be associated with metabolic acidosis. We report a case of severe renal tubular acidosis (Type IV) with life-threatening hyperkalaemia caused by spironolactone, and discuss the mechanisms by which this may occur.     

终末期糖尿病肾病肾替代治疗

肾替代治疗（RRT）是终末期糖尿病肾病（DN）的主要治疗手段，作者对近年有关终末期DN血液透析、腹膜透析、肾移植等方面的文献作一系统性回顾，旨在指导临床合理治疗终末期DN。