Diabetic ketoacidosis

..

351
4

39 30/

260
./. Serum Na= 135 mEq /L, Serum potassium= 4 mEq /L, Serum Chloride = 100 mEq
/L, Serum HCO3= 13 mEq /L, blood sugar= 250 ./. Serum ketone= positive
BUN/Cr=40/1
Serum HCO3= 13 mmol/L
arterial blood gas pH=7.25,
PO2=100,PCo2= 30, HCO3= 12, O2Sat= 98%
Diabetic ketoacidosis (blood sugar= 250
./.), Serum ketone = positive Serum HCO3
arterial blood gas pH=7.25

0.9%NSS 300./.
5%D/NSS 80 ./. 5
5 1. 143 ./.
1. 150-180 ./.

ceftriaxone 2 ICU

Diabetic ketoacidosis (DKA)


DKA
glucagons,catecholamine,cortisol growth hormone
1

1 diabetic ketoacidosis
: http://ucsf.mightyminnow.com/images/charts/5.e_rev1.jpg

hyperglycemic hyperosmolar
nonketotic syndrome (HHNS) (lipolysis)
DKA 2

2
: http://www.kemeta.com/images/kemetaPresentationGoogleLong.003.jpg

1.

glucagoncounterregulatory hormone
osmotic diuresis
poor
skin turgor

2.

(lipolysis)free fatty acid(FFA)

3.serum sodium
100./. 100./.1.6-1.8
mEq/L

Corrected Serum Na =serum Na + ( BS-100 ) x 1.6

100

1 2
1

thiazide, steroid
(1)
1.plasma glucose > 300-350 /.
euglycemic DKA plasma glucose
2.anion gap (serum HCO3<15 mEq/L arterial pH
< 7.3)
Anion gap = (Na+) (HCO3-+ Cl-)
3.

1 diabetic ketoacidosis
(:American Diabetes Association From Diabetes Care Vol 29, Issue 12, 2006.)

1.
2. 0.9% NaCl
1 0.9% NaCl 1000
2 0.9% NaCl 500-1000
3 0.9% NaCl 500
4 0.9% NaCl 250
DKA5-6 <250-300 ./.
5%D/NSS/280-100.
3.( regular insulin,RI)
3.1

RI 10 (0.1/. 1.)RI
5-10/.(0.1/. 1./.)
. 75-100/. RI RI
2-3/.

RINSS 1 /.
100.
RI 24-48.
RI intermediate-acting insulin(NPH)
3.2


RI 10 5-10 5-10
1. <250-300 ./. RI4-6.
5% 10%D/NSS/2

RI
DKA
4.
DKA

potassium
serum potassium 5 mEq /L
K < 3 mEq /L KCL 20-30 mEq
K = 3-4 mEq /L KCL 10 mEq
K = 4-5 mEq /L KCL 5 mEq
5.
kussmual serum
HCO3<7 mEq/L arterial pH<6.9-7
50mEqNSS/2 100.
60
6.
7.
DKA
7-10
DKA
1.
2.
3.
DKA
4.
250-300/.

5.< 250 /.

6.

7.

8. RI NPH
DKA
9.

351
,

Diabetic ketoacidosis 0.9%NSS5%D/NSS

0.9%NSS
250
./. 5%D/NSS
5 5
150-180 ./. 0.9%NSS 2
5%D/NSS 80./.

ceftriaxone 2 2

1. .. .
.1 .. ; 2548 : 1-190.
2. . ENDOCRINE EMERGENCY.
.
3. Edward D. Buckingham, M.D., Francis B. Quinn, M.D., Francis B. Quinn, Jr., M.D.
Endocrinology December 15, 1999.Available from:
URL:http://www.utmb.edu/otoref/grnds/Endocrinology-991215/Endocrinology.htm