文档介绍：糖尿病急慢性并发症
山东大学齐鲁医院
张晓黎

第一课时:
糖尿病急性并发症
糖尿病急性并发症
糖尿病酮症酸中毒
高血糖高渗透压综合征(HHS)
乳酸酸中毒
Case History
A 19-year-old female patient was brought into the casualty department in an irritable and atose state.
She had no important past medical history but her parents stated that she had been treated by her GP for a urinary infection with antibiotics some five days earlier. Since then, she had e progressively worse. She had been going to the toilet frequently (which had been put down to the urinary infection) and had been feverish and anorexic. In the past 24 hours she had begun vomiting plained of quite severe abdominal pain. She had e progressively more drowsy and when reviewed by her GP was sent into hospital directly.
Physical Examination
She was indeed in a semiconscious and rather irritable state.
She was flushed with warm peripheries, and her pulse was 110 beats/min in sinus rhythm with good volume. Temperature was ℃, blood pressure 95/70mmHg and respiratory rate 30/min.
She was rather dehydrated and grimaced when her abdomen was palpated, although there was no guarding or rebound tenderness, and bowel sounds were present normally.
Results
Sodium: 128mmol/l , Potassium: , Chloride: 91mmol/l, Plasma CO2 content: 8mmol/l
Urea: , Creatinine: 286umol/l, Blood glucose: , Serum amylase: 530u/l
Haemoglobin: , HCT: %, WCC: *103/mm3
PH: , pO2: (123mmHg), pCO2: (14mmHg), Base excess: -17mmol/l, Actual HCO3: 9mmol/l, Standard HCO3: 11mmol/l
Questions
What is the diagnosis and, briefly, why has it occurred?
Could the diagnosis have been made without the laboratory tests, and if so how?
Explain the reasons for all the abnormalities in the results quoted.
糖尿病酮症酸中毒(Diabetic ketoacidosis, DKA)
是糖尿病急性代谢紊乱并发症之一;
可作为糖尿病的首发表现;
常见于急诊和门诊,是内科重要急症之一;
要求迅速、合理的治疗,误诊误治会导致较高的死亡率。;
定义
为糖尿病控制不良所产生的一种需要急诊治疗的情况。是由于胰岛素不足及升糖激素不适当升高,引起糖、脂肪和蛋白质代谢紊乱,以至水、电解质和酸碱平衡失调,以高血糖、高血酮和代谢性酸中毒为主要表现的临床综合征。
概述
酮症
糖尿病酮症