英国糖尿病住院患者联合治疗协会指南纳入了有关高渗性高血糖状态合并糖尿病酮症酸中毒的修订建议。
英国糖尿病住院患者联合治疗协会(Joint British Diabetes Societies for Inpatient Care, JBDS-IP)发布了最新的成人高渗性高血糖状态(hyperosmolar hyperglycaemic state, HHS)管理指南。修订后的指南详细介绍了关于管理这类高血糖急症的新建议,包括:
对于 HHS 合并糖尿病酮症酸中毒(diabetic ketoacidosis, DKA)患者,在开始静脉输液后,采取以 0.1 U/(kg·h) 固定速率的静脉胰岛素输注(fixed rate intravenous insulin infusion, FRIII)。
该输注速率符合 JBDS-IP 对单纯 DKA 患者的建议。
目标治疗以使血糖以 4.0-6.0 mmol/(L·h)(72-108 mg/[dL·h])速率降低。
如果 16-18 岁患者由成人糖尿病团队接收管理,则遵循成人指南的建议。如果 18 岁以下患者由儿科团队接收管理,则遵循儿科指南的建议。
小结
定义
病史和体格检查
关键诊断因素
- 急性认知损害
- 存在的危险因素
其他诊断因素
- 多尿
- 多饮
- 体重减轻
- 恶心和呕吐
- 无力
- 黏膜干燥
- 皮肤弹性差
- 心动过速
- 低血压
- 体温过低
- 少尿
- 腹痛
- 局灶性神经系统体征
- 癫痫发作
危险因素
- 感染
- 胰岛素或者口服降糖药治疗不充分
- 已知糖尿病患者的急性疾病
- 家庭护理居住者
- 术后状态
- 诱发药物
- 全胃肠外营养 (TPN)
- 库欣综合征
- 甲状腺功能亢进症
- 肢端肥大症
诊断性检查
首要检查
- 血糖
- 血清酮体
- 静脉血气
- 血清渗透压
- 尿素、电解质和肌酐
- 全血细胞计数
- 心电图(ECG)
需考虑的检查
- 尿液分析
- 心肌酶
- 胸部 X 线检查
- 肝功能检测
- C 反应蛋白
- 血液、尿液、痰液培养
治疗流程
血钾 <3.5 mmol/L(<3.5 mEq/L)
血钾 3.5-5.5 mmol/L(3.5-5.5 mEq/L)
血钾 >5.5 mmol/L(>5.5 mEq/L)
撰稿人
专家顾问
Edward Jude, MBBS, DNB, MRCP
Honorary Professor of Medicine
University of Manchester
Consultant Physician/Diabetologist/Endocrinologist
Tameside and Glossop Integrated Care NHS Foundation Trust
Manchester
UK
利益声明
EJ declares that he has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:
Natasha Khazai, MD
Endocrinologist
Joslin Diabetes Clinic
Boston
MA
Guillermo Umpierrez, MD
Professor of Medicine
Emory University School of Medicine
Atlanta
GA
利益声明
NK declares that she has no competing interests. GU is supported by research grants from the American Diabetes Association and the National Institutes of Health, and has received research funds from Sanofi-Aventis, Novo Nordisk, Takeda, and GlaxoSmithKline.
同行评议者
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
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.
Edward Jude, MBBS, DNB, MRCP
Honorary Professor of Medicine
University of Manchester
Consultant Physician/Diabetologist/Endocrinologist
Tameside and Glossop Integrated Care NHS Foundation Trust
Manchester
UK
利益声明
EJ declares that he has no competing interests.
编辑
Annabel Sidwell
Section Editor, BMJ Best Practice
利益声明
AS 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
- 糖尿病酮症酸中毒 (DKA)
- 乳酸酸中毒
- 酒精性酮症酸中毒
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