糖尿病酮症酸中毒

最后审阅: 1 十一月 2022
最后更新: 18 十一月 2022

小结

定义

病史和体格检查

关键诊断因素

  • 已知有糖尿病或糖尿病特征
  • 恶心和/或呕吐
  • 腹痛
  • 脱水
  • 过度换气
  • 意识模糊
  • 存在的危险因素
  • 体温过低
完整详情

其他诊断因素

  • 呼吸时有丙酮味
完整详情

危险因素

  • 胰岛素治疗不足或不适当
  • 感染
  • 心肌梗死
  • 胰腺炎
  • 卒中
  • 肢端肥大症
  • 甲状腺功能亢进症
  • 药物(例如皮质类固醇、噻嗪类药物、喷他脒、拟交感神经药、第二代抗精神病药物、可卡因、免疫检查点抑制剂或 SGLT-2 抑制剂)
  • 库欣综合征
  • 西班牙或黑人血统
  • 肥胖症手术
完整详情

诊断性检查

首要检查

  • 静脉血气
  • 血清酮体
  • 血糖
  • 尿素和电解质
  • 全血细胞计数
完整详情

需考虑的检查

  • 尿液分析
  • 心电图(ECG)
  • 妊娠试验
  • 淀粉酶和脂肪酶
  • 心肌酶
  • 肌酐激酶
  • 胸部 X 线检查
  • 肝功能检测
  • 血液、尿液、痰液培养
完整详情

治疗流程

急症处理

初始收缩压 <90 mmHg

初始收缩压 ≥90 mmHg

撰稿人

专家顾问

Gerry Rayman, MD, FRCP

Consultant Physician and Head of Service

Diabetes and Endocrine Centre and the Diabetes Research Unit

Ipswich Hospitals NHS Trust

Ipswich

UK

简介

GR is Lead and Innovator of the National Inpatient Diabetes Audit; and Joint Clinical Lead of the Diabetes, Getting It Right First Time programme.

利益声明

GR has been paid for advisory board meetings with the following companies: Sanofi Aventis, Abbott Diabetes UK, Lilly Diabetes, and Bayer. GR has received lecture fees from Sanofi Aventis, Abbott Diabetes UK, Lilly Diabetes, Novo Nordisk, and Napp Pharmaceuticals Ltd.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:

Aidar R. Gosmanov, MD, PhD, FACE

Associate Professor of Medicine

Division of Endocrinology

Albany Medical College

Chief, Endocrinology Section

Albany VAMC

Albany

NY

Laleh Razavi Nematollahi, MD

Assistant Professor of Medicine

Case Western Reserve University

Cleveland

OH

利益声明

ARG and LRN declare that they have no competing interests.

同行评议者

Edward Jude, MD, MRCP

Consultant Diabetologist and Endocrinologist

Tameside and Glossop Integrated Care NHS Foundation Trust

Honorary Professor, University of Manchester

Honorary Professor, Manchester Metropolitan University Manchester

UK

利益声明

EJ declares that he has no competing interests.

Ketan Dhatariya, MBBS, MSc, MD, MS, FRCP, PhD

Honorary Professor of Medicine

Norwich Medical School, University of East Anglia

Consultant Diabetes & Endocrinology

Norfolk and Norwich University Hospitals NHS Foundation Trust

Norwich

UK

利益声明

KD is the chair of the Joint British Diabetes Societies for Inpatient Care. KD has received honoraria from Diabetes Professional Care to speak at its annual meeting about these guidelines. No other reimbursement has been received from commercial organisations with respect to these guidelines. KD has helped to develop educational materials on this subject for the European Association for the Study of Diabetes, but did not receive any reimbursement. For other work as the chair of JBDS, KD has received honoraria from Lilly for developing educational material.

编辑

Annabel Sidwell

Section Editor, BMJ Best Practice

利益声明

AS declares that she has no competing interests.

Luisa Dillner

Head of Research and Development, BMJ

利益声明

LD declares that she has no competing interests.

Anna Ellis

Head of Editorial, BMJ Best Practice

利益声明

AE declares that she has no competing interests.

Rachel Wheeler

Lead Section Editor, BMJ Best Practice

利益声明

RW declares that she has no competing interests.

Julie Costello

Comorbidities Editor, BMJ Best Practice

利益声明

JC declares that she has no competing interests.

Adam Mitchell

Drug Editor, BMJ Best Practice

利益声明

AM declares that he has no competing interests.

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