Kitabchi A E, Wall B M
Department of Medicine, University of Tennessee, Memphis, College of Medicine, 38163, USA.
Am Fam Physician. 1999 Aug;60(2):455-64.
Diabetic ketoacidosis is an emergency medical condition that can be life-threatening if not treated properly. The incidence of this condition may be increasing, and a 1 to 2 percent mortality rate has stubbornly persisted since the 1970s. Diabetic ketoacidosis occurs most often in patients with type 1 diabetes (formerly called insulin-dependent diabetes mellitus); however, its occurrence in patients with type 2 diabetes (formerly called non-insulin-dependent diabetes mellitus), particularly obese black patients, is not as rare as was once thought. The management of patients with diabetic ketoacidosis includes obtaining a thorough but rapid history and performing a physical examination in an attempt to identify possible precipitating factors. The major treatment of this condition is initial rehydration (using isotonic saline) with subsequent potassium replacement and low-dose insulin therapy. The use of bicarbonate is not recommended in most patients. Cerebral edema, one of the most dire complications of diabetic ketoacidosis, occurs more commonly in children and adolescents than in adults. Continuous follow-up of patients using treatment algorithms and flow sheets can help to minimize adverse outcomes. Preventive measures include patient education and instructions for the patient to contact the physician early during an illness.
糖尿病酮症酸中毒是一种紧急医疗状况，如果治疗不当可能会危及生命。这种病症的发病率可能在上升，自20世纪70年代以来，1%至2%的死亡率一直居高不下。糖尿病酮症酸中毒最常发生于1型糖尿病患者（以前称为胰岛素依赖型糖尿病）；然而，其在2型糖尿病患者（以前称为非胰岛素依赖型糖尿病），尤其是肥胖黑人患者中的发生并不像曾经认为的那样罕见。糖尿病酮症酸中毒患者的管理包括获取详尽但快速的病史并进行体格检查，以试图找出可能的诱发因素。这种病症的主要治疗方法是首先进行补液（使用等渗盐水），随后补钾并进行小剂量胰岛素治疗。大多数患者不建议使用碳酸氢盐。脑水肿是糖尿病酮症酸中毒最严重的并发症之一，在儿童和青少年中比在成人中更常见。使用治疗算法和流程图对患者进行持续随访有助于将不良后果降至最低。预防措施包括患者教育以及指导患者在患病期间尽早联系医生。
