糖尿病酮症酸中毒患者死亡的相关因素

目的:探讨糖尿病酮症酸中毒患者死亡的相关因素.方法:研究对象选择我院收治的70例糖尿病酮症酸中毒患者,选择时间2020年3月-2021年3月,采用回顾性分析方法对患者的临床资料进行归纳总结,分析患者死亡的相关因素.结果:经过治疗可知15例患者死亡,归纳引发患者死亡因素,分别为性别、年龄、糖尿病史、入院意识、感染、脑卒中...     

糖尿病酮症酸中毒

糖尿病酮症酸中毒(DKA)是由于体内的胰岛素缺乏引起的以高血糖、高酮血症和代谢性酸中毒为主要改变的临床综合征,是糖尿病的急性合并症,也是内科常见的急症之一。其发病率,国外统计约占住院糖尿病患者的14％,我院统计为14.6％。糖尿病酮症酸小毒昏迷在胰岛素应用前足糖尿病患者死亡的主     

糖尿病酮症酸中毒急性腹痛的分析

糖尿病酮症酸中毒是糖尿病的一种严重急性并发症，临床表现复杂，有时以急性腹痛就诊。本文对12例糖尿病酮症酸中毒急性腹痛病例的诊断治疗情况作一回顾性分析。     

糖尿病酮症酸中毒的防治

糖尿病酮症酸中毒的防治北京医科大学附属第一医院北京１０００３４钱荣立概述糖尿病酮症酸中毒（ＤＫＡ）是糖尿病最常见的急性代谢并发症，我院统计约占住院糖尿病人的１４．６％，特别多见于年轻的Ⅰ型糖尿病患者，中老年Ⅱ型糖尿病患者在某些应激和感染情况下，也会因...     

老年人糖尿病酮症酸中毒并多器官功能衰竭

老年人糖尿病酮症酸中毒并多器官功能衰竭霍沛艾糖尿病酮症酸中毒（ＤＫＡ）多发生于年青的胰岛素依赖型糖尿病（ＩＤＤＭ）病人，但一些老年非胰岛素依赖型糖尿病（ＮＩＤＤＭ）病人由于某些诱因亦可发生ＤＫＡ，并常并发多器官功能衰竭，如未能及时诊治，病死率颇高。老...     

糖尿病酮症酸中毒并肝损害临床分析

目的探讨导致糖尿病酮症（ＤＫ）及酮症酸中毒（ＤＫＡ）患者肝损害的相关因素．方法ＤＫ或ＤＫＡ患者９９例,其中ＡＬＴ及ＡＳＴ均异常升高１１例（Ａ组）,单项ＡＬＴ异常升高１３例（Ｂ组）,肝功能正常７５例（Ｃ组）,对以上各组患者的血二氧化碳结合力（ＣＯ２ＣＰ）、尿素氮（ＢＵＮ）、血糖（ＢＧ）和血浆渗透压（ＯＳＭ）进行了统计分析．结果Ａ,Ｂ两组患者的ＣＯ２ＣＰ明显低于Ｃ组（Ｐ＜００１,ｔ＝６３３和ｔ＝６４３）,而ＢＵＮ则明显升高（Ｐ＜００１,ｔ＝３６１,ＡｖｓＣ;Ｐ＜００１,ｔ＝４３５,ＢｖｓＣ）,Ａ组的ＢＧ（Ｐ＜００５,ｔ＝２８４）和血浆ＯＳＭ（Ｐ＜００５,ｔ＝３１０）水平也显著高于Ｃ组,而Ｂ组患者的ＢＧ及血浆ＯＳＭ与Ｃ组比较无差异;与Ｂ组相比,Ａ组患者的ＣＯ２ＣＰ明显降低（Ｐ＜００２,ｔ＝２７１）,ＢＧ（Ｐ＜００５,ｔ＝２８９）和血浆ＯＳＭ（Ｐ＜００５,ｔ＝２３６）明显升高．此外,Ⅰ型糖尿病患者血清转氨酶异常升高的发生率明显高于Ⅱ型糖尿病患者（Ｐ＜００５,χ２＝４３８）．结论酸中毒和脱水是导致糖尿病酮症及酮症酸中毒患者肝损害的重要因素,酸中毒及脱水程度与肝损害程度相关．     

糖尿病酮症酸中毒58例临床分析

目的探讨糖尿病酮症酸中毒（DKA）的诱因、临床特点及救治方法。方法回顾性分析58例DKA患者的临床资料。结果DKA最常见的诱因是感染,其次为停用或减少胰岛素及口服降糖药、饮食不当或劳累、急性脑血管疾病、精神刺激;全部患者均有不同程度脱水、低血容量性休克、口干、多饮、多尿、烦躁不安、意识改变、消化道症状;采用小剂量胰岛素持续静滴及积极纠正水电解质紊乱,加强抗感染等综合治疗,抢救成功55例。结论DKA发病诱因复杂,可引起一系列严重的代谢紊乱;及时诊断、治疗是成功抢救DKA患者的关键。     

糖尿病酮症酸中毒并发急性胰腺炎临床分析

酮症酸中毒(ＤＫＡ)是糖尿病常见的急性代谢并发症。常因1型糖尿病减量或停用胰岛素或2型糖尿病在严重感染、创伤、手术等应激状态下所诱发。其临床表现除口干、多饮、多尿加重、脱水明显外,常以消化道症状为突出表现,如腹痛、恶心、呕吐等,因而常需与急腹症相鉴别,若在ＤＫＡ基础上又并发急性胰腺炎时,由于两者的临床表现相重迭,极易使胰腺炎漏诊,故需引起重视。现将我们诊治的5例总结如下。临床资料一般资料　5例患者,男2例,女3例。年龄26～51岁,1型糖尿病1例,2型糖尿病4例,糖尿病史3.5～8年。入院前1型糖尿病和1例2型糖尿病患者使用胰岛…     

90例糖尿病酮症酸中毒临床分析

本文总结了近8年收治的DKA90例，旨在探讨DKA病情严密监护及合理治疗措施。     

妊娠期糖尿病酮症酸中毒

妊娠期糖尿病酮症酸中毒（DKA）是妊娠期危重急症,严重威胁母儿生命,但缺乏大型系统性研究,普遍对其认识不足。该文对妊娠期DKA的流行病学、病理生理机制、诱因、临床表现、诊断及治疗进行介绍,阐述妊娠期DKA与非妊娠期DKA的不同、对胎儿的影响等,从多层面解析妊娠期DKA的特点。     

Diabetic Ketoacidosis in Type 2 Diabetics: A Novel Presentation of Pancreatic Adenocarcinoma

Diabetic ketoacidosis (DKA) has been the hallmark of a life-threatening medical emergency for poorly controlled or newly diagnosed type 1 diabetics. In the last two decades, this traditional association has been challenged with increasing reports of type 2 diabetics presenting with DKA. We report the case of a 75-year-old woman with known type 2 diabetes who presented in DKA and was found to have pancreatic adenocarcinoma. A link between diabetes mellitus and pancreatic cancer has been investigated, but the literature remains inconclusive as to whether diabetes mellitus (DM) is a cause or result of pancreatic cancer or simply the confluence of two common entities. Previous case reports of pancreatic tumors presenting with DKA all represented neuroendocrine tumors. Adenocarcinoma of the pancreas should be considered in the list of precipitants for DKA in type 2 DM.     

糖尿病酮症酸中毒30例临床分析

目的探讨糖尿病酮症酸中毒(DKA)的诱因及抢救方法,提高对DKA的治愈率,减少病死率。方法对我院近5年收治的30例DKA患者进行临床分析,分析诱因及治疗方法。结果30例DKA中1型糖尿病(T1DM)14例,2型糖尿病(T2DM)15例,类固醇性糖尿病1例,T1DM引起DKA大多数无诱因,少数是停用胰岛素而诱发。T2DM引起DKA最常见的诱因是感染,类固醇性糖尿病是激素和静脉滴注葡萄糖注射液引起,采用小剂量胰岛素持续静脉滴注及积极纠正水电解质紊乱,加强抗感染治疗,疗效满意,30例患者抢救成功。结论积极防治诱因,综合治疗,合理使用抗生素是防治DKA的关键。     

Diabetic Ketoacidosis

Reviews in Endocrine and Metabolic Disorders -     

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency in patients with diabetes mellitus. DKA most often occurs in patients with type 1 diabetes, but patients with type 2 diabetes are susceptible to DKA under stressful conditions, such as trauma, surgery, or infections. DKA is reported to be responsible for more than 100 000 hospital admissions per year in the US, and accounts for 4-9% of all hospital discharge summaries among patients with diabetes. Treatment of patients with DKA uses significant healthcare resources and accounts for 1 out of every 4 healthcare dollars spent on direct medical care for adult patients with type 1 diabetes in the US. Recent studies using standardized written guidelines for therapy have demonstrated a mortality rate of less than 5%, with higher mortality rates observed in elderly patients and those with concomitant life-threatening illnesses. Worldwide, infection is the most common precipitating cause for DKA, occurring in 30-50% of cases. Urinary tract infection and pneumonia account for the majority of infections. Other precipitating causes are intercurrent illnesses (i.e., surgery, trauma, myocardial ischemia, pancreatitis), psychological stress, and non-compliance with insulin therapy. The triad of uncontrolled hyperglycemia, metabolic acidosis and increased total body ketone concentration characterizes DKA. These metabolic derangements result from the combination of absolute or relative insulin deficiency and increased levels of counter-regulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). Successful treatment of DKA requires frequent monitoring of patients, correction of hypovolemia and hyperglycemia, replacement of electrolyte losses, and careful search for the precipitating cause. Since the majority of DKA cases occur in patients with a known history of diabetes, this acute metabolic complication should be largely preventable through early detection, and by the education of patients, healthcare professionals, and the general public. The frequency of hospitalizations for DKA has been reduced following diabetes education programs, improved follow-up care, and access to medical advice. Novel approaches to patient education incorporating a variety of healthcare beliefs and socioeconomic issues are critical to an effective prevention program.     

血液净化治疗糖尿病酮症酸中毒的疗效分析

目的分析血液净化治疗方式在糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)的疗效。方法回顾性分析2010年1月—2014年12月发病的糖尿病酮症酸中毒患者158例,分为血液净化治疗组和非血液净化治疗组,统计患者一般资料、临床症状、实验室检查、并发症、住院时间,非血液净化治疗组给予小剂量胰岛素持续泵入+补液等治疗,血液净化组给予血液透析或者血液透析滤过治疗。结果 1血液净化治疗组患者临床症状、并发症明显高于非血液净化治疗组,两组比较差异有统计学意义(P0.05);2血液净化组患者实验室指标均在4 h左右恢复正常,与非血液净化治疗组比较,差异有统计学意义(P0.01);3血液净化治疗组住院时间较非血液净化治疗组短,两组比较,差异有统计学意义(P0.05,P=0.023)。结论血液净化治疗能够快速降低糖尿病酮症酸中毒实验室指标,缓解临床症状,缩短住院时间。     

抢救糖尿病酮症酸中毒80例临床分析

糖尿病酮症酸中毒(DKA)是由于体内胰岛素缺乏而胰岛素的反调激素增加,引起糖、脂肪和蛋白质代谢紊乱,并以高血糖、高酮血症和代谢性酸中毒为主要表现的临床综合征,及时合理的治疗,对提高患者生命质量及降低病死率是非常必要的。现将我院抢救的80例患者病例资料报道如下。资料与方法一般资料本组80例DKA患者(男44,女36),年龄20～65岁,平均年龄40.5岁。既往有糖尿病史68例,病程0.5～30年,12例既往未发现糖尿病,20例反复发作DKA。临床表现复杂多样,三多一少为主者有40例,占50%;急腹症为主者有20例,占25%;昏迷为主者有8例,占10%;表情淡漠为…     

Management of Diabetic Ketoacidosis

Reviews in Endocrine and Metabolic Disorders -     

以酮症酸中毒为首发症状的小儿糖尿病临床分析

目的探讨以酮症酸中毒为首发症状的小儿糖尿病的临床治疗效果。方法选择36例以酮症酸中毒为首发症状的小儿糖尿病患者随机分成两组,对照组接受常规治疗方案,研究组在常规治疗方案基础上实施小剂量胰岛素治疗,对比两组的血糖控制水平、实验室检查结果及治疗有效率。结果与对照组相比,研究组尿素氮的检测结果偏高,C反应蛋白、钠离子、氯离子检测结果偏低(P<0.05),钾离子、钙离子水平及白细胞计数情况两组差异无统计学意义(P>0.05),而研究组患儿的血糖控制情况及治疗总有效率明显优于对照组(P<0.05)。结论为取得更优的治疗效果,需尽早对小儿糖尿病酮症酸中毒患者做出明确诊断,为患者及时补液,并进行小剂量胰岛素静脉滴注,这可以最大程度的帮助患者控制病情,挽救患儿的宝贵生命。     

Ketoacidosis in Ethiopian diabetics

Summary The clinical features of 44 episodes of diabetic ketoacidosis in 34 Ethiopians were similar to those reported from other nations. The mortality was only 9.1%, even though serum potassium, bicarbonate and pH could not be measured. Although 3 patients were new diabetics, and the cause was not found in 7, most cases resulted from omission of insulin (43%) or intercurrent illness (28%). Socioeconomic factors, particularly the cost and unreliability of insulin supplies, are major obstacles to the control of diabetes and the prevention of ketoacidosis in Ethiopian patients.Presented at the 15th Annual Conference of the Ethiopian Medical Association, May 1979     

Pneumomediastinum in Diabetic Ketoacidosis

A 13-year-old girl was admitted with diabetic ketoacidosis. She was found to have a pneumomediastinum. This resolved spontaneously on correction of the metabolic disturbance. The condition is generally benign.