血酮監(jiān)測(cè)在現(xiàn)代糖尿病中的臨床意義復(fù)習(xí)過程

1、血酮監(jiān)測(cè)在現(xiàn)代糖尿病管理中的臨床意義胰島素胰島素胰升糖素胰升糖素 脂肪分解脂肪酸丙二酸單酰CoA肉堿脂酰轉(zhuǎn)移酶I肉堿肝臟線粒體+脂肪酸氧化酮體酮體酮體生成增多的機(jī)制酮體生成增多的機(jī)制酸性代謝產(chǎn)物SymptomsNausea/vomitingThirst/polyuriaAbdominal painAltered mental functionShortness of breathPrecipitating eventsInadequate insulin administrationInfection (pneumonia/UTI/gastroenteritis/sepsis)Infarcti

2、on (cerebral, coronary,mesenteric, peripheral)Drugs (cocaine)Physical findingsTachycardiaDry mucous membranes/reducedskin turgorDehydration / hypotensionTachypnea / Kussmaul respirations/respiratory distressAbdominal tenderness (may resembleacute pancreatitis or surgicalabdomen)FeverLethargy /obtund

3、ation / cerebraledema / possibly comaNOTE: UTI, urinary tract infection.1 Komulainen J, et al. Arch Dis Child. 1996;75:4104152Rewers A, et al. JAMA. 2002;287:251125183Fishbein HA, Palumbo PJ. In Diabetes in America. National Diabetes Data Group, NIH, 1995, 283291David B. Dunger, et al. Pediatrics 20

4、04;113;133-140 在美國，如果每年有10萬人因DKA住院，每人的住院費(fèi)為1.3萬美元，那么每年的花費(fèi)將超過10億美元*Lebovitz HE: Diabetic ketoacidosis. Lancet 345:767772, 1995*American Diabetes Association. Test of glycemia in diabetes. Diabetes Care 1999;22:s77-79酮體的三種成分1. Kitabchi A, et al. Diabetic Keteoacidosis & hypoglycemic hyperosmolar non-ketotic state. In: Khan C, Weir G, eds. Joslins Diabetes Mellitus. Philadelphia: Lea and Febiger; 1994: 738-770.此課件