每小时使用格拉斯哥昏迷量表进行评估,以监测是否发生脑水肿。[42]Joint British Diabetes Societies Inpatient Care Group. The management of diabetic ketoacidosis in adults. September 2013 [internet publication].
https://www.diabetes.org.uk/resources-s3/2017-09/Management-of-DKA-241013.pdf
脑水肿的其他特征包括复发性呕吐、失禁、易激惹、呼吸异常和颅神经功能障碍。这些症状通常发生在开始治疗后数小时。[42]Joint British Diabetes Societies Inpatient Care Group. The management of diabetic ketoacidosis in adults. September 2013 [internet publication].
https://www.diabetes.org.uk/resources-s3/2017-09/Management-of-DKA-241013.pdf
[61]Kitabchi AE, Wall BM. Management of diabetic ketoacidosis. Am Fam Physician. 1999 Aug;60(2):455-64.
http://www.ncbi.nlm.nih.gov/pubmed/10465221?tool=bestpractice.com
如果怀疑有脑水肿,请立即寻求上级医生和危重症诊疗医生的支持。 给予甘露醇。[62]Meaden CW, Kushner BJ, Barnes S. A rare and lethal complication: cerebral edema in the adult patient with diabetic ketoacidosis. Case Rep Emerg Med. 2018 Mar 21;2018:5043752.
https://www.doi.org/10.1155/2018/5043752
http://www.ncbi.nlm.nih.gov/pubmed/29755797?tool=bestpractice.com
若格拉斯哥昏迷量表评分恶化或者患者新发头痛或头痛恶化,应考虑进行头颅 CT 检查。[137]Dixon AN, Jude EB, Banerjee AK, et al. Simultaneous pulmonary and cerebral oedema, and multiple CNS infarctions as complications of diabetic ketoacidosis: a case report. Diabet Med. 2006 May;23(5):571-3.
http://www.ncbi.nlm.nih.gov/pubmed/16681567?tool=bestpractice.com
脑水肿的确切病因尚不明确。最常发生于儿童和青少年,而在 28 岁以上的患者中很少见。这是 DKA 最常见的死亡原因。[42]Joint British Diabetes Societies Inpatient Care Group. The management of diabetic ketoacidosis in adults. September 2013 [internet publication].
https://www.diabetes.org.uk/resources-s3/2017-09/Management-of-DKA-241013.pdf
[61]Kitabchi AE, Wall BM. Management of diabetic ketoacidosis. Am Fam Physician. 1999 Aug;60(2):455-64.
http://www.ncbi.nlm.nih.gov/pubmed/10465221?tool=bestpractice.com
[2]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
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