Schumann Christina, Faust Michael
Dtsch Med Wochenschr. 2018 Mar;143(6):384-391. doi: 10.1055/s-0043-114493. Epub 2018 Mar 15.
Diabetic ketoacidosis and the hyperosmolar hyperglycemic state are the most serious diabetic emergencies. Before the discovery of insulin in 1921 by Banting and Best the diagnosis of type 1 diabetes was fatal ending in diabetic ketoacidosis equivalent to a torturous death. Today, mortality from diabetic ketoacidosis is low at approximately 2 %. But each death from these two acute metabolic complications of diabetes is potentially avoidable by improved patient and healthcare professional education. Therefore, there is a need to raise awareness of hyperglycemic crisis and its management amongst physicians.
Insulin deficiency or resistence and increased concentrations of counterreulatory hormones (glucagon, catecholamines, cortisol and growth hormone) are responsible for the development of diabetic ketoacidosis and the hyperosmolar hyperglycemic state. Hyperglycemia develops as a result of increased gluconeogenesis and accelerated glyconeogenesis. In DKA, the absolute insulin deficiency additionally leads to increased lipolysis and production of ketone bodies and resulting metabolic acidosis.
Both DKA and HHS require prompt recognition and management. The diagnosis can be suspected by clinical features and confirmed by laboratory findings.
The treatment of DKA and HHS is similar, including correction of fluid and electrolyte abnormalities and the administration of insulin.
糖尿病酮症酸中毒和高渗高血糖状态是最严重的糖尿病急症。在1921年班廷和贝斯特发现胰岛素之前，1型糖尿病的诊断是致命的，最终会发展为糖尿病酮症酸中毒，相当于一种痛苦的死亡。如今，糖尿病酮症酸中毒的死亡率较低，约为2%。但通过改善患者和医护人员的教育，这两种糖尿病急性代谢并发症导致的每一例死亡都有可能避免。因此，有必要提高医生对高血糖危象及其管理的认识。
胰岛素缺乏或抵抗以及升糖激素（胰高血糖素、儿茶酚胺、皮质醇和生长激素）浓度升高是糖尿病酮症酸中毒和高渗高血糖状态发生的原因。高血糖是由于糖异生增加和糖原分解加速所致。在糖尿病酮症酸中毒中，绝对的胰岛素缺乏还会导致脂肪分解增加和酮体生成，进而导致代谢性酸中毒。
糖尿病酮症酸中毒和高渗高血糖状态都需要迅速识别和处理。可根据临床特征怀疑诊断，并通过实验室检查结果确诊。
糖尿病酮症酸中毒和高渗高血糖状态的治疗相似，包括纠正液体和电解质异常以及给予胰岛素。
