Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
Norwich Medicine School, University of East Anglia, Norwich, UK.
Diabet Med. 2022 Jun;39(6):e14788. doi: 10.1111/dme.14788. Epub 2022 Feb 27.
This article summarises the Joint British Diabetes Societies for Inpatient Care guidelines on the management of ketoacidosis; available at https://abcd.care/resource/management-diabetic-ketoacidosis-dka-adults. The document explicitly states that when a person aged 16-18 is under the care of the paediatric team, then the paediatric guideline should be used, and if they are cared for by an adult team, then this guideline should be used. The guideline takes into account new evidence on the use of the previous version of this document, particularly the high prevalence of hypoglycaemia and hypokalaemia, and recommends that when the glucose concentration drops below 14 mmol/L, that de-escalating the insulin infusion rate from 0.1 to 0.05 units/kg/h should be considered. Furthermore, a section has been added to address the recognition that use of sodium glucose co-transporter 2 inhibitors is associated with an increased risk of euglycaemic ketoacidosis. The management of ketoacidosis in people with end-stage renal failure or on dialysis is also mentioned. Finally, the algorithms to illustrate the guideline have been updated.
本文总结了联合英国住院患者护理学会关于酮症酸中毒管理的指南；可在 https://abcd.care/resource/management-diabetic-ketoacidosis-dka-adults 上获取。该文件明确指出，当 16-18 岁的人由儿科团队护理时，应使用儿科指南，如果由成人团队护理，则应使用本指南。该指南考虑了关于该文件前一版本使用的新证据，特别是低血糖和低钾血症的高患病率，并建议当血糖浓度降至 14mmol/L 以下时，应考虑将胰岛素输注率从 0.1 单位/公斤/小时降至 0.05 单位/公斤/小时。此外，还增加了一节内容，以认识到使用钠-葡萄糖共转运蛋白 2 抑制剂会增加血糖正常酮症酸中毒的风险。还提到了终末期肾病或透析患者的酮症酸中毒的管理。最后，更新了说明指南的算法。
