48例糖尿病酮症酸中毒及昏迷的临床治疗分析

目的：探讨糖尿病酮症酸中毒及其昏迷的发病原因及临床治疗的效果;方法：收集近年来我院收治的48例糖尿病酮症酸中毒厦昏迷患者治疗情况的临床资料,并根据患者不同的年龄结构分成两组进行分析研究,探讨糖尿病酮症酸中毒及昏迷患者入院治疗的临床效果;结果：48例糖尿病酮症酸中毒及昏迷患者经过入院定期观察治疗,病灶得到缓解;结论：糖尿病酮症酸中毒及昏迷患者中以中老年人,尤其是老年人居多,发病的患者要坚持长期补充血容量,坚持用胰岛素治疗,并纠正电解质厦酸碱平衡失调。对于轻微患者要早诊断,早发现,早治疗,防止发生并发症,通过合理治疗并坚持锻炼身体病情会得到缓解。     

儿童糖尿病合并酮症酸中毒17例临床特点分析

目的分析小儿糖尿病酮症酸中毒的临床表现及治疗效果。方法对17例儿童糖尿病酮症酸中毒的临床表现、实验室检查及可能引起的t误诊进行总结分析。结果经过小剂量胰岛素持续静脉应用及对症治疗,17例患儿均抢救成功。结论及时正确诊断,积极抢救,且小剂量胰岛素静脉滴注治疗小儿糖尿病酮症酸中毒是成功的关键。     

妊娠合并糖尿病并发酮症酸中毒临床处理

文章介绍了妊娠合并糖尿病并发酮症酸中毒的发病诱因和诊断，主要阐明了治疗酮症酸中毒的关键：合理补液，静脉胰岛素滴注降低血糖，纠正电解质紊乱，恰当的产科处理是降低母儿不良结局的重要措施。     

糖尿病酮症酸中毒并发脑水肿临床分析

目的探讨儿童糖尿病酮症酸中毒并发脑水肿的临床特征及危险因素。 方法对重庆医科大学附属儿童医院1993—2005年住院治疗的糖尿病酮症酸中毒并发脑水肿患儿的临床特征及病因进行分析，并与未并发者进行对照比较。 结果在71例酮症酸中毒患儿中，有6例临床表现符合脑水肿的诊断标准，临床确定为并发脑水肿，并发率为84%。6例均为重型酮症酸中毒。与未发生脑水肿同等程度的重型酮症酸中毒患儿相比较，并发脑水肿患儿酸中毒更为严重，在治疗期间血钠上升缓慢及持续低钠血症，尿素氮水平升高。6例患儿中有5例应用碳酸氢盐治疗，用量大于未并发者。 结论糖尿病儿童并发重型酮症酸中毒易发生脑水肿。严重酸中毒、血钠上升缓慢或持续低钠血症、血尿素氮升高及碳酸氢盐的使用有可能增加脑水肿发生的危险性。     

糖尿病酮症酸中毒临床48例诊治分析

目的：探讨糖尿病酮症酸中毒（DKA）的救治方案。方法：回顾性分析本院2009年10月至2011年6月收治的48例DKA患者的临床资料。结果：26例DKA患者主要诱因是感染,9例自己停用胰岛素,2例妊娠,7例是饮酒及饮食过多,4例无明显诱因,经治疗均得到纠正,血糖控制良好,经2～4周调整治疗治愈出院。结论：早期诊断,及时应用胰岛素治疗、补液是DKA抢救成功的关键。     

妊娠期糖尿病酮症酸中毒的预测及预警

妊娠期糖尿病酮症酸中毒是一种少见但却潜在威胁母儿生命安全的疾病。多见于1型糖尿病合并妊娠的患者,也可见于2型糖尿病合并妊娠患者和妊娠期糖尿病患者。对妊娠期糖尿病酮症酸中毒进行早期的识别和诊断,对改善母儿结局意义重大。文章就妊娠期糖尿病酮症酸中毒的病理生理、对母儿的影响、诱发因素、预测因子、早期预警信号及预测模型等进行论述。     

妊娠糖尿病并发酮症及酮症酸中毒的诊断与处理

妊娠糖尿病并发酮症及酮症酸中毒时对母儿健康危害较大，尤其当发生糖尿病酮症酸中毒(diabetic ketoacidosis，DKA)，如不及时抢救或处理不当，则孕产妇死亡率高且围产儿死亡率亦高达35％。现将我院近年来收治的妊娠糖尿病并发酮症及酮症酸中毒8例，分析报道如下。     

地塞米松和舒喘灵致糖尿病孕妇酮症酸中毒一例

酮症酸中毒是糖尿病的一种严重急性并发症。产科的常用药物地塞米松和硫酸舒喘灵都能影响糖代谢,但由此而引起的糖尿病孕妇酮症酸中毒,国内少有报道。近期我院有1例因用地塞米松和硫酸舒喘灵致糖尿病孕妇酮症酸中毒,现报道如下。 病历摘要:患者,女,29岁,孕3产0,糖尿病史2年、孕34~+周、腹胀痛半天,拟诊为糖尿病合并妊娠、先兆早产入院。患者2年前诊为Ⅱ型糖尿病,服用“拜糖平”至孕4月,后改用胰岛素(RI)治疗,孕20周开始于我院产前检查,自行监测血糖并调整RI用量,血糖控制满意,入院时早、中、晚餐前RI各20u、12u、13u皮下肌注。患者此前二     

胰岛素冲击治疗酮症酸中毒患者的疗效观察

目的：探讨和研究胰岛素冲击治疗糖尿病酮症酸中毒患者的疗效与安全性。方法：病例选取为2012年4月至2013年7月之间收治的44例糖尿病酮症酸中毒患者，随机将其分为22例治疗组和22例对照组，治疗组患者进行一次性静脉冲击后持续给予胰岛素静滴，对照组患者则仅采用持续静滴胰岛素治疗，对两组患者的抢救成功率、胰岛素用量、补液量、治疗时间以及低血糖发生率等情况进行统计对比。结果：从抢救成功率、胰岛素用量、补液量对比来看，两组患者并无显著差异（P〉0．05），但治疗组治疗用时显著低于对照组（P〈0．05），低血糖发生率治疗组为13．6％，对照组为0．0％，治疗组明显高于对照组（P〈0．05）。结论：一次性静脉冲击治疗酮症酸中毒能够迅速缓解患者病情，但低血糖发生率也随之增加，建议根据患者情况不同选取正确治疗方案。     

浅析暴发性1型糖尿病诊治

1型糖尿病包括自身免疫性（1A）和特发性（1B）两种类型。暴发性1型糖尿病就属于1B型，其病情发展迅速，可在短期内出现严重高血糖和酮症酸中毒。这类患者占酮症或酮症酸中毒引起的Ⅰ型糖尿病患者的15％～20％．这种疾病和HLAⅡ类抗原和病毒感染有一定的联系。由于发病迅速，虽然患者的血糖很高，但是HBAIC水平几乎正常。所以遇到超高血糖而HBAIC接近正常的酮症中毒的患者，我们应该考虑暴发性1型糖尿病，因其发展迅速，抢救更需及时。     

妊娠期糖尿病酮症酸中毒的处理

妊娠期糖尿病酮症酸中毒是一种少见的产科危重症,是以高血糖、高血酮、严重脱水和代谢性酸中毒为主要临床表现的一种综合征,若治疗不及时则母婴死亡率及病率明显升高。及时给予紧急补充血容量,同时辅以胰岛素补充治疗。病情多能快速缓解,母儿预后良好。     

Normoglycemic diabetic ketoacidosis in pregnancy.

The clinical presentation of diabetic ketoacidosis in pregnancy is usually the same as in nonpregnant women, although the blood glucose may not be as high as in the nongravid state. We report a case of a pregnant woman who developed diabetic ketoacidosis with a normal blood glucose and review the pertinent medical literature. A 29-year-old woman with type I diabetes developed diabetic ketoacidosis during induction of labor. She had a glucose level of 87 mg per 100 ml with ketonuria, a metabolic acidosis, and an anion gap of 20 mmol l(-1). Normoglycemic diabetic ketoacidosis during pregnancy is truly unusual but can occur with relatively low, or even normal, blood sugars and necessitates prompt recognition and treatment. In this case, the combination of an initial episode of hypoglycemia and subsequent blood glucose levels below 95 mg per 100 ml led to a prolonged delay in the initiation of a planned insulin infusion for insulin coverage during the induction of labor. A significant ketoacidosis consequently developed, despite the absence of even a single elevated blood glucose measurement. This case illustrated the importance of not withholding insulin in a patient with type I diabetes for more than a few hours even if the blood glucose is normal.     

Treatment of severe diabetic ketoacidosis in the early third trimester in a patient with fetal distress. A case report

A patient presented with severe diabetic ketoacidosis at 30 weeks' gestation. Her case was complicated by uterine contractions and fetal distress. Treatment with rehydration and continuous infusion of insulin not only reversed the diabetic ketoacidosis but also stopped the uterine contractions and fetal distress. Ketoacidosis can stimulate uterine contractions and cause signs of fetal distress; these problems can be reversed by adequately treating the diabetic ketoacidosis.     

Women's health in the 21st century

Although women's health has been under-attended for most of the 20th century, it has gained international attention in recent decades. Medical and social research on heart disease, lung cancer, HIV/AIDS, and trachoma indicate that bio-socio variables affect women's health differently from men's. With regard to diabetes, data on pregnancy, diabetic ketoacidosis (DKA), depression, and heart disease corroborate the differentials between men and women. Data also indicate that social factors place diabetic women at a disadvantage regarding access to treatment and outcomes. Ascertaining the precise interactions that cause these differences and applying this information to policies and programs are imperative in the 21st century.     

妊娠合并糖尿病酮症酸中毒的识别和处理

妊娠合并糖尿病酮症酸中毒是产科严重的合并症,如未能及时诊断及处理,会造成母儿严重的不良结局.本文就妊娠合并DKA的临床识别及处理进行讨论.     

Diabetic ketoacidosis and insulin resistance with subcutaneous terbutaline infusion: a case report

Diabetic ketoacidosis may occur in women treated with intravenous beta-sympathomimetic agents for tocolysis. We describe diabetic ketoacidosis and transient severe insulin resistance in a woman with diabetes who was treated with subcutaneous terbutaline infusion. Subcutaneous terbutaline infusion may precipitate transient insulin resistance and diabetic ketoacidosis in women with diabetes.     

Fulminant type 1 diabetes during pregnancy: A case report and review of the literature

Fulminant type 1 diabetes, classified as a subtype of nonautoimmune type 1 diabetes, may result in severe complications for both mother and fetus due to the sudden onset of diabetic ketoacidosis. Little is known about the clinical features of pregnancy with fulminant type 1 diabetes. We present a case of fulminant type 1 diabetes during pregnancy, along with a review of the published literature. A 31-year-old Japanese woman presented with sudden onset of nausea and vomiting at 36 weeks' gestation and was provisionally diagnosed with acute gastroenteritis. She was referred to us for investigation of exaggerated general fatigue and intrauterine fetal death. Based on blood and urinary examinations, she was diagnosed with diabetic ketoacidosis, caused by fulminant type 1 diabetes. Although her ketoacidosis was improved, insulin therapy was needed. Awareness of this disease can lead to prompt diagnosis and treatment and consequently, improved maternal and fetal prognosis.     

Hypertriglyceridemic pancreatitis during pregnancy. A report of a case

Acute pancreatitis during pregnancy is an uncommon complication. The usual cause is biliary tract disease. Cholesterol and triglyceride plasma levels physiologically increase during pregnancy. Pregravidic hypertriglyceridemia (as much primary as secondary) may be exacerbated and occasionally act as the trigger. Early diagnosis and treatment are the keys because related morbidity and mortality are high. We report a case of diabetic ketoacidosis and hypertriglyceridemia-induced gestational pancreatitis (tryglicerid level of 12,100 mg/dL) treated successfully with conservative management. The clinical, biochemical and therapeutic aspects comment in addition of this pathology, as well as its prevention