小结
定义
DKA 是糖尿病的一种急性代谢并发症，可能危及生命，需要及时就医进行成功治疗。它的特点是胰岛素绝对或相对缺乏，是 1 型糖尿病最常见的急性高血糖性并发症。[1][2]
[Figure caption and citation for the preceding image starts]: DKA 三联征经许可后改编自：Kitabchi AE, Wall BM.糖尿病酮症酸中毒Med Clin North Am.1995;79:9-37. [Citation ends].
本专题涵盖成人糖尿病酮症酸中毒。请记住，根据地方规定，16-18 岁的患者可由儿科团队或成人医疗团队接收管理。2021 年英国糖尿病联合会住院患者诊疗组（Joint British Diabetes Societies for Inpatient Care）指南建议，如果患者由儿科团队接收管理，应遵循儿科指南，如果患者由成人团队接收管理，则应遵循成人指南。[2][3]
英国儿科内分泌学和糖尿病学会（British Society for Paediatric Endocrinology and Diabetes）发布了儿童 DKA 管理指南。[3]
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
其他诊断因素
- 呼吸时有丙酮味
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
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
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
治疗流程
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.
鉴别诊断
- 高渗性高血糖状态 (HHS)
- 乳酸酸中毒
- 饥饿性酮症
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