당뇨병성 케톤산증과 고혈당 고삼투압성 혼수의 치료(Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state)

소개글

당뇨병성 케톤산증과 고혈당 고삼투압성 혼수의 치료(Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state)에 대한 보고서 자료입니다.

목차

DKA & HHS (hyperglycemic hyperosmolar state)

Pathogenesis
Underlying metabolic abnormality Result from
In DKA

Acid basebalance, fluid & electrolyte
Acidosis in DKA
Metabolic acidosis
Hyperglycemia induced osmotic diuresis
Hyponatremia
Potassium depletion
Precipitating factors

Diagnosis
Clinical presentation
Dehydration
Definitive diagnosis of DKA or HHS
Clinical finding
Hyperglycemia
Osmolality
PH
Elevated leucocyte
Elevated amylase in DKA
Lipase
Blood culture, urinalysis, urine culture,

Treatment
Cormorbid precipitating event must be treated
DKA & HHS
Fluid therapy
Insulin therapy
Potassium therapy
Bicarbonate therapy
Phosphate therapy

Treatment related complication
Cerebral edema
Adult respiratory distress syndrome
Hyperchloremic metabolic acidosis
Vascular thrombosis
Hypoglycemia and hypokalemia

본문내용

DKA & HHS (hyperglycemic hyperosmolar state)
; most serious acute metabolic complication of DM, and associated with excess motality
(motality rate ; DKA 4% ~ 10%, HHS 10% ~ 50%)
Pathogenesis
Underlying metabolic abnormality
Result from
Absolute or relative insulin deficiency
Increased counter-regulatory hormones
In DKA
Low insulin & increased catecholamine & cortisol & growth hormone
activate hormone sensitive lipase
breakdown of triglyceride & release of free fatty acid
free fatty acid change to ketone body
Ketogenesis ; is stimulated by glucagon
Glucagon stimulate carnitine pamitoyl transferase I
Free fatty acid coenz A ; to cross mitochondrial
membrane after their esterification to carnitine
Esterification fatty acyl Coenz A
enter β oxidative pathway
produce acetyl coenz A
β – hydroxy butyric acid
& acetoacetic acid ; this two are
responsible for acidosis in DKA
β – hydroxy butyric acid & acetoacetic acid & acetone ; filtered by kidney in urine
Volume depletion reduced GFR greater ketone retension
The reason of absence of ketosis in HHS is not known (because of lower level of free fatty acids or higher portal vein insulin level ???)
Acid basebalance, fluid & electrolyte
Acidosis in DKA ; due to β – hydroxy butyric acid & acetoacetic acid
these two ketoacids dissociate completely excess hydrogen bind bicarbonate decrease serum bicarbonate

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키워드

DKA,   diabetic ketoacidosis,   HHS,   hyperglycemic hyperosmolar coma,   diabetes,   당뇨병,   당뇨병성 케톤산증,   파워포인트