糖尿病酮症酸中毒

对于以下情况，考虑存在 DKA：

• 已知有糖尿病且身体情况不佳的患者[2]Joint British Diabetes Societies for Inpatient Care. The management of diabetic ketoacidosis in adults. June 2021 [internet publication]. https://abcd.care/sites/abcd.care/files/site_uploads/JBDS_Guidelines_Current/JBDS_02%20_DKA_Guideline_amended_v2_June_2021.pdf [4]Misra S, Oliver NS. Diabetic ketoacidosis in adults. BMJ. 2015 Oct 28;351:h5660. http://www.ncbi.nlm.nih.gov/pubmed/26510442?tool=bestpractice.com [17]Karslioglu French E, Donihi AC, Korytkowski MT. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. BMJ. 2019 May 29;365:l1114. https://www.doi.org/10.1136/bmj.l1114 http://www.ncbi.nlm.nih.gov/pubmed/31142480?tool=bestpractice.com

  • DKA 最常见于 1 型糖尿病患者，但也可见于 2 型糖尿病患者。[1]Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes Care. 2009 Jul;32(7):1335-43. http://care.diabetesjournals.org/content/32/7/1335.full http://www.ncbi.nlm.nih.gov/pubmed/19564476?tool=bestpractice.com [2]Joint British Diabetes Societies for Inpatient Care. The management of diabetic ketoacidosis in adults. June 2021 [internet publication]. https://abcd.care/sites/abcd.care/files/site_uploads/JBDS_Guidelines_Current/JBDS_02%20_DKA_Guideline_amended_v2_June_2021.pdf

• 口渴加重、多尿、近期不明原因体重下降或过度劳累，以及存在以下任意表现的患者：[17]Karslioglu French E, Donihi AC, Korytkowski MT. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. BMJ. 2019 May 29;365:l1114. https://www.doi.org/10.1136/bmj.l1114 http://www.ncbi.nlm.nih.gov/pubmed/31142480?tool=bestpractice.com [43]National Institute for Health and Care Excellence. Type 1 diabetes in adults: diagnosis and management. Aug 2022 [internet publication]. https://www.nice.org.uk/guidance/ng17 [48]National Institute for Health and Care Excellence. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. Jun 2022 [internet publication]. https://www.nice.org.uk/guidance/ng18 http://www.ncbi.nlm.nih.gov/pubmed/32200593?tool=bestpractice.com

  • 恶心

  • 呕吐

  • 腹痛[4]Misra S, Oliver NS. Diabetic ketoacidosis in adults. BMJ. 2015 Oct 28;351:h5660. http://www.ncbi.nlm.nih.gov/pubmed/26510442?tool=bestpractice.com [49]Umpierrez G, Freire AX. Abdominal pain in patients with hyperglycemic crises. J Crit Care. 2002 Mar;17(1):63-7. http://www.ncbi.nlm.nih.gov/pubmed/12040551?tool=bestpractice.com

  • 过度通气（Kussmaul 呼吸）[50]Whited L, Graham DD. Abnormal respirations. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2019. https://www.ncbi.nlm.nih.gov/books/NBK470309

  • 脱水

  • 意识模糊。

紧急安排静脉血气、血酮和毛细血管血糖检测。