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。     

肠内、肠外补液治疗糖尿病急性并发症的比较

<正>糖尿病急性并发症包括酮症酸中毒(DKA)非酮症高渗性昏迷(NHDC)等,是导致糖尿病患者死亡的重要原因[1]。针对这些并发症,早期充分补液十分关键[2]。然而,传统的静脉补液治疗存在一定的局限,临床上时常面对补液量不足和补液过多导致不良反应的矛盾[3]。作者采用随机对照队列研究的方法,对比了经胃肠道补液为     

青少年糖尿病酮症酸中毒合并高渗性昏迷的急救

目的:探讨青少年糖尿病酮症酸中毒合并高渗性昏迷的急救方法.方法:采取静脉补液联合胃肠道补液,小剂量静脉胰岛素微泵降糖,适宜补碱,维持电解质平衡.防治并发症及患者监测等治疗.结果:22例患者中21例抢救成功,只有1例因严重并发症死亡.结论:经过积极正确的急救,青少年糖尿病酮症酸中毒合并高渗性昏迷的抢救成功率高,预后可.     

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。     

两种补液途径治疗糖尿病酮症酸中毒疗效比较

目的比较经静脉联合胃管补液与单纯静脉补液对糖尿病酮症酸中毒患者的治疗效果及安全性。方法回顾性分析62例糖尿病酮症酸中毒患者的临床资料,62例依据补液径路分为静脉联合胃管补液组（联合补液组,32例）与单静脉补液组（30例）,观察两组患者病情转归及治疗过程中脑水肿、低血钾、心力衰竭、心律失常的发生率。结果两组患者治疗有效率比较差异无统计学意义（P〉0.05）;与B组相比,A组患者发生脑水肿占6.25%、低血钾占3.16%、心力衰竭占3.16%（P〈0.05）,心律失常为3.16%,两组比较差异无统计学意义（P〉0.05）。结论经静脉联合胃管补液患者治疗过程中脑水肿、低血钾、心力衰竭的发生率低。     

双重补液治疗高渗性非酮症性糖尿病昏迷21例的护理

总结21例高渗性非酮症性糖尿病昏迷患者的护理。重视病情观察,做好静脉补液、胃肠道补液护理,加强胰岛素用药护理。治愈15例,好转4例,自动出院1例,死亡1例。     

糖尿病酮症酸中毒患者不同补液途径的临床疗效对比

我院自2003年以来采用胃肠道补液为主纠正糖尿病酮症酸中毒（DKA），与传统静脉补液相比取得满意效果，现报告如下。 1 对象和方法 1．1 对象 DKA的诊断标准：原有糖尿病症状加重或新出现糖尿病症状伴有脱水，呼吸深大等酸中毒表现，血糖≥16．7mmol／L，血pH值〈7．3或HCO3≤12mmol／L，尿糖、尿酮体强阳性，伴脱水、不能正常饮食。     

糖尿病酮症酸中毒并发急性胰腺炎20例

目的了解糖尿病酮症酸中毒并发急性胰腺炎的临床特点,提高对其的诊断及治疗。方法回顾性分析糖尿病酮症酸中毒并发急性胰腺炎20例患者的临床特点。结果 20例并发急性胰腺炎患者中19例治疗后痊愈,1例抢救无效死亡。结论对糖尿病酮症酸中毒患者应及时做血、尿淀粉酶及胰腺彩超及CT检查,尽早禁食及胃肠减压,积极补液、静脉滴注小剂量胰岛素、抑酸、抑制胰酶活性等是糖尿病酮症酸中毒并发急性胰腺炎治疗的关健。     

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。     

1例胃肠补液治疗糖尿病酮症酸中毒病人的护理

美国糖尿病协会(ADA)推荐的糖尿病酮症酸中毒(DKA)治疗原则包括:密切观察病情、纠正低血容量及高血糖、补充丢失电解质、寻找诱发因素[1].在ADA指导文件中,关于DKA补液治疗,一直沿用传统的静脉补液[1,2].我科2010年收治1例糖尿病酮症酸中毒病人,采用以胃肠补液为主,配合静脉补液治疗DKA[3,4],效果满意.现报道如下.     

Risk of ketosis during intensive insulin therapy in pre-school-age diabetic children

The risk of ketosis and its relationship to the mode of insulin therapy were studied in a subset of pre-school-age diabetic children. These five children, who initially responded poorly to standard in-hospital diabetes management, were selected for a program of intensified therapy directed at achieving more stable blood glucose control. Optimized conventional therapy was first employed for 16 +/- 5 mo and did not improve substantially blood glucose level or stability. During this period, there was an average of almost one episode of ketonuria per patient per month, and three diabetic ketoacidosis episodes were observed. Because of its limited efficacy, the treatment was then changed to continuous subcutaneous insulin infusion. This mode of therapy had a rapid favorable effect on blood glucose control, with no concomitant increase of the frequencies of ketonuria or diabetic ketoacidosis, most of which occurred during the first months of insulin pump therapy. Deliberate cessation of either conventional or subcutaneous insulin infusion therapy for 7 h under close in-hospital control resulted in similar metabolic changes: a slight nonconstant increase of blood glucose, and an abrupt rise of blood 3-hydroxybutyrate to 3 mM, with massive ketonuria. The management of these young diabetic children with insulin pump therapy was thus not associated with an increased frequency or an accelerated rate of development of ketosis. However, the possible failures originating from the infusing device and the rapid increase of ketosis in young ages require special vigilance from the parents, based on twice-daily urine testing for ketones and appropriate insulin supplementation.     

Effect of 3-hydroxybutyrate infusion on urinary protein excretion in healthy man

Diabetic ketoacidosis is often associated with a temporary increase in protein excretion, but the mechanisms are not completely known. The aim of the present study was to examine the effect of acute experimental moderate ketosis on kidney function and specifically on protein handling using an infusion of 3-hydroxybutyrate in healthy subjects. Seven young healthy males were infused with sodium 3-hydroxybutyrate, the peak blood level attained being 1.96 +/- 0.53 mmol/l (SD). The pH in blood and urine rose significantly from 7.40 +/- 0.03 to 7.45 +/- 0.05 (2p less than 0.01) and from 7.29 +/- 0.79 to 8.51 +/- 0.82 (2p less than 0.01), respectively. Urinary beta-2-microglobulin excretion rose significantly from 0.038 microgram/min x/ divided by 1.9 to 0.082 microgram/min x/ divided by 1.4 (geometric mean x/ divided by tolerance factor) (2p less than 0.01) but urinary albumin excretion was unchanged. No changes were seen in blood pressure, glomerular filtration rate and renal plasma flow. A marked reduction in urine flow from 15 to 5 ml/min was noted, but could not be attributed to changes in plasma arginine-vasopressin, which was reduced before and during infusion due to considerable oral water loading. It is concluded that moderate elevation in blood ketone body levels does not induce albuminuria. It is suggested that the temporary proteinuria present in diabetic ketoacidosis may be related to acidosis per se.     

Ketoacidotic conditions in patients with diabetes mellitus (problems of classification and therapeutic tactics)

The paper is concerned with the characteristics of ketoacidotic conditions in patients with diabetes mellitus. The results of the clinical observation over 434 patients suffering from diabetes mellitus associated with diabetic ketoacidotic conditions of different gravity are analyzed. The causes that promoted the development of such complications and the clinico-biochemical characteristics of the patients are presented. Based on the analysis of the patients' condition, the laboratory and clinical findings the authors stress the necessity of differentiating between diabetic ketosis and ketoacidosis. The treatment measures are discussed in terms of the complications. It is indicated that in the treatment of ketoacidosis use can be made of splenin. The mechanisms of the beneficial effect of the drug on diabetic ketoacidosis are under discussion. It is also emphasized that diabetic ketoacidosis may develop in patients with any type and gravity of diabetes mellitus. Diabetic ketosis and ketoacidosis are regarded as different stages of the same disease. In case of the late and erroneous therapy any ketosis may transform to ketoacidosis.     

肾移植后糖尿病酮症酸中毒18例

背景：随着免疫抑制剂的应用,肾移植受者的内分泌和糖类、脂类代谢也发生了变化,肾移植后糖尿病酮症已成为影响患者移植后短期及长期存活率的一项严重并发症,直接影响到人肾存活。目的：分析肾移植后糖尿病酮症酸中毒发病的相关因素,总结肾移植后糖尿病酮症酸中毒的救治方法,降低死亡率。方法：回顾性分析2003/2009郑州人民医院肾移植科收治的18例肾移植后糖尿病酮症酸中毒患者的临床资料,既往肾移植前有糖尿病病史者2例,均为2型糖尿病;无糖尿病病史者16例。酮症发生的时间为肾移植后3d～2.5年。早期临床表现为倦怠乏力、肌肉酸痛、发热等。随着病情的发展很快出现脱水和神经系统症状及体征。对症给予小剂量胰岛素,补液,纠正电解质酸碱平衡失调,去除诱因以及针对并发症等治疗。结果与结论：治疗成功13例,人/肾存活良好,成功率72%;3例死亡,1例死于感染性休克,2例死于多器官功能衰竭,病死率17%;2例患者救治成功,但移植肾功能丧失,恢复血液透析。提示肾移植后糖尿病酮症酸中毒是与抗排斥药物及移植肾功能密切相关的严重的肾移植后并发症,临床表现不典型,处理不当易致严重后果,需引起临床足够重视。     

Diabetic ketoacidosis

A diagnosis of diabetic ketoacidosis requires the patient's plasma glucose concentration to be above 250 mg per dL (although it usually is much higher), the pH level to be less than 7.30, and the bicarbonate level to be 18 mEq per L or less. Beta-hydroxybutyrate is a better measurement of the degree of ketosis than serum ketones. Intravenous insulin and fluid replacement are the mainstays of therapy, with careful monitoring of potassium levels. Phosphorous and magnesium also may need to be replaced. Bicarbonate therapy rarely is needed. Infection, insulin omission, and other problems that may have precipitated ketoacidosis should be treated. Myocardial infarction is a precipitating cause of diabetic ketoacidosis that is especially important to look for in older patients with diabetes. Cerebral edema is a major complication that occurs primarily in children. Education to prevent recurrence should be offered to all patients, including how to manage sick days and when to call a physician.     

Combating diabetic ketoacidosis and other hyperglycemic-ketoacidotic syndromes.

Diabetic ketoacidosis is an acute medical emergency that requires immediate diagnosis and treatment. Diagnosis may be established rapidly by measurement of urinary glucose and ketones, arterial blood pH and blood gases, and serum ketones. Rapid infusion of large volumes of fluids and electrolytes, together with continuous infusion of low doses of insulin, provides effective restoration of fluid and electrolyte balance and correction of metabolic derangements. Hyperosmolar nonketotic coma is characterized by marked hyperglycemia in the absence of ketoacidosis and occurs usually in patients with mild adult-onset diabetes. Symptoms develop more slowly than in diabetic ketoacidosis. Treatment is the same for both conditions. In alcoholic ketoacidosis, hyperketonemia is present without hyperglycemia. The syndrome differs from diabetic ketoacidosis in that blood glucose levels are lower and glycosuria is absent. Treatment consists of intravenous administration of dextrose in water and, if necessary, of sodium bicarbonate. Insulin administration usually is not necessary.     

Ketoacidosis in long-term therapy with insulin pumps. Incidence, causes, circumstances

110 type I diabetic patients were treated with CSII from 1980 to the end of 1988 on a routine basis over a total of 337 patient years and a mean of 36.7 months per patient. 14 cases of severe diabetic ketoacidosis (DKA) were seen in 14 patients representing an accumulated incidence of one episode of DKA per 209 patients months. DKA occurred on an average of 25 months after start of CSII therapy. The main causes of DKA were undetected leakage of the infusion system in nine, infection in three and mismanagement of the pump in two cases. Technical or electronic failures could be excluded in each case. The lack of checking urine for ketones, the wrong feeling of safety after long-term successful pump treatment, and a concomitant psychological stress situation favoured the misjudgement of the clinical symptoms of ketosis and the delay of hospital admission.     

Nationwide survey to compare the prevalence of transient elevation of liver transaminase during treatment of diabetic ketosis or ketoacidosis in new-onset acute and fulminant type 1 diabetes mellitus

Background aims. A mild increase in liver enzyme levels is sometimes observed in patients with diabetic ketosis or ketoacidosis. The aim of the present study was to assess the cause and prevalence of the elevation of liver transaminase levels in fulminant and acute-onset type 1 diabetic patients experiencing diabetic ketosis or ketoacidosis.

Methods. We analyzed data on the liver transaminase levels of 108 patients over 18 years of age with newly diagnosed type 1 diabetes complicated by ketosis or ketoacidosis. The data were collated from a nationwide survey on fulminant type 1 diabetes and retrospective medical records.

Results. Thirty-two (60.4%) out of the 53 patients suffering from fulminant type 1 diabetes were detected with transient elevation of liver transaminase (TELT) levels during the first month after initiation of insulin therapy; in the case of acute-onset type 1 diabetes, such an observation was noted in 16 (29.1%) out of 55 patients. Fatty liver was diagnosed in 20% of the patients, and 65% of these patients exhibited TELT. The dosage of insulin injected in these patients was significantly high.

Conclusions. High blood glucose and fatty liver may influence the elevation of liver transaminase levels during the treatment of new-onset type 1 diabetes.     

小剂量胰岛素治疗儿童糖尿病酮症酸中毒及护理

目的 探讨小剂量胰岛素持续滴注治疗儿童糖尿病酮症酸中毒的护理方法.方法 对8例1型糖尿病酮症酸中毒患儿,在积极抢救治疗的基础上,注意严密观察病情变化,给予正确的液体治疗、小剂量胰岛素等治疗及护理.结果 8例患儿均好转,原发病病情稳定,血糖控制满意.结论 小剂量胰岛素法治疗糖尿病酮症酸中毒易于掌握,安全有效.护士熟练掌握...     

微量泵注入胰岛素在糖尿病酮症酸中毒抢救中的应用

目的观察微量注射泵胰岛素输注在糖尿病酮症酸中毒抢救中的疗效。方法将193例糖尿病酮症酸中毒患者随机分成研究组和对照组,研究组102例,对照组91例。研究组用微量注射泵持续静脉推注胰岛素,对照组持续静脉滴注胰岛素,观察两组血糖下降速度及血酮消除的速度,以及出现低血糖的风险等。结果与对照组比较,研究组血糖下降更平稳;血酮体阴转时间[(26.25±17.92)h vs.(30.82±18.27)h]、低血糖发生人次[(1.20±2.02)人次vs.(1.93±3.16)人次]及平均住院日[(9.19±4.07)d vs.(11.37±5.77)d]明显降低(P<0.05)。结论微量泵胰岛素输注在糖尿病酮症酸中毒中的抢救效果优于传统的小剂量胰岛素持续静脉滴。