[내과]DKA treatment (당뇨병성 케톤산증의 치료)

소개글

당뇨 합병증 중 DKA (당뇨병성 케톤산증)/ hyperglycemic hyperosmolar state의 진단 및 치료, 병태생리 등에 관해 정리해 놓은 파워포인트 자료입니다.


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목차

Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state

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

Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state
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

참고 자료

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