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糖尿病酮症酸中毒:病理生理学与管理的当前评估

Diabetic ketoacidosis: a current appraisal of pathophysiology and management.

作者信息

Koul Pulin B

机构信息

Department of Pediatrics, College of Medicine, University of Florida, Jacksonville, Florida, USA.

出版信息

Clin Pediatr (Phila). 2009 Mar;48(2):135-44. doi: 10.1177/0009922808323907. Epub 2008 Nov 20.

Abstract

Diabetic ketoacidosis (DKA) is a frequent abnormal metabolic entity seen in high-dependency units such as critical care units and in the emergency department. Having an understanding of its pathophysiology, a consequence of absent to low insulin levels, delineates the clinical presentation. Most clinical features are caused by hyperglycemia and acidosis, including weight loss. The newer management modalities are discussed that include the need for intensive laboratory workup, meticulous monitoring of the insulin, and fluid management. Among the complications, cerebral edema (CE) is the most dreaded, albeit with low incidence. The new insights into its pathophysiology and management are outlined, and a timeline for management of DKA is proposed.

摘要

糖尿病酮症酸中毒(DKA)是一种常见的异常代谢状态,见于重症监护病房等高依赖病房以及急诊科。了解其病理生理学(胰岛素水平缺乏至降低的结果)有助于明确临床表现。大多数临床特征由高血糖和酸中毒引起,包括体重减轻。文中讨论了新的治疗方法,包括进行全面实验室检查的必要性、胰岛素的精细监测以及液体管理。在并发症中,脑水肿(CE)最为可怕,尽管其发生率较低。概述了对其病理生理学和治疗的新见解,并提出了DKA的治疗时间线。

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