Wachtel T J
Community Health, Brown University, Providence, Rhode Island.
Clin Geriatr Med. 1990 Nov;6(4):797-806.
The diabetic hypersomolar state is defined by a serum glucose greater than 600 mg/dl and a serum osmolarity greater than 320 m Osm/L. Ketoacidosis or lactic acidosis may co-exist with DHS in the same patient. The incidence of this acute complication of diabetes is high enough (17.5 cases per 100,000 person-years) for primary care physicians to encounter a case every year or two. Predisposing factors include older age, female sex, nursing home residence, and infection. A substantial proportion of cases occur in patients with no prior history of diabetes. Common presenting signs include fatigue or weakness, polydipsia, polyuria, nausea, and alteration of consciousness. The mainstay of therapy is intravenous fluid replacement with close monitoring of glucose and electrolytes in a hospital setting. Current mortality figures are high, at 10% to 20%, and the chance of survival is adversely affected by older age, higher osmolarity, and the presence of an associated severe illness. Prevention includes screening for diabetes, educating diabetic patients and their care givers about the symptoms of hyperglycemia, prompt treatment of any infection in a diabetic person, avoidance of drugs that increase carbohydrate intolerance in diabetic people, and encouraging compliance with treatment of diabetes.
糖尿病高渗状态的定义为血清葡萄糖大于600mg/dl且血清渗透压大于320mOsm/L。酮症酸中毒或乳酸酸中毒可能与糖尿病高渗状态在同一患者中并存。这种糖尿病急性并发症的发病率足够高（每10万人年17.5例），以至于初级保健医生每1到2年就会遇到1例。诱发因素包括老年、女性、居住在养老院以及感染。相当一部分病例发生在既往无糖尿病病史的患者中。常见的临床表现包括疲劳或虚弱、多饮、多尿、恶心以及意识改变。治疗的主要方法是在医院环境中静脉补液并密切监测血糖和电解质。目前的死亡率很高，为10%至20%，年龄较大、渗透压较高以及存在相关严重疾病会对生存机会产生不利影响。预防措施包括糖尿病筛查、对糖尿病患者及其护理人员进行高血糖症状教育、及时治疗糖尿病患者的任何感染、避免使用会增加糖尿病患者碳水化合物不耐受的药物以及鼓励糖尿病患者坚持治疗。
