糖尿病酮症酸中毒管理:特定患者群体的更新和挑战

A. El-Remessy
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引用次数: 0

摘要

糖尿病酮症酸中毒(DKA)是最常见的高血糖紧急情况,也是糖尿病患者可预防的死亡风险最大的疾病。DKA在1型糖尿病患者中更常见,30%的病例发生在2型糖尿病患者身上。DKA的特点是严重的高血糖、代谢性酸中毒和酮症酸中毒。DKA的正确管理需要住院进行积极的置换,并监测液体、电解质和胰岛素治疗。DKA的管理已经更新了指导方针,以帮助标准化护理,降低死亡率和发病率。DKA的主要诱因包括糖尿病的新诊断、不坚持胰岛素治疗以及糖尿病患者的感染。出院计划应包括适当选择胰岛素剂量和方案,以及对患者进行教育,以防止DKA复发。此外,还讨论了在使用钠-葡萄糖共转运蛋白2抑制剂的患者中,正常血糖DKA的定义和管理。特别考虑特定患者群体,包括妊娠、肾替代、急性胰腺炎、胰岛素泵使用者以及新冠肺炎患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Diabetic Ketoacidosis Management: Updates and Challenges for Specific Patient Population
Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency and causes the greatest risk for death that could be prevented in patients with diabetes mellitus. DKA occurs more commonly among patients with type-1 diabetes with a thirty percent of the cases take place in patients with type 2 diabetes. DKA is characterized by sever hyperglycemia, metabolic acidosis and ketosis. Proper management of DKA requires hospitalization for aggressive replacement and monitoring of fluids, electrolytes and insulin therapy. Management of DKA has been updated with guidelines, to help standardize care, and reduce mortality and morbidity. The major precipitating factors for DKA include new diagnosis of diabetes, non-adherence to insulin therapy as well as infection in patients with diabetes. Discharge plans should include appropriate selection of insulin dosing and regimens as well as patient education to prevent recurrence of DKA. Further, definition and management of euglycemic DKA in patients prescribed sodium-glucose co-transporter 2 inhibitors are discussed. Special consideration is reviewed for specific patient population including pregnancy, renal replacement, acute pancreatitis, and insulin pump users as well as patients with COVID-19.
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