Gonzalez-Campoy J M, Robertson R P
Division of Diabetes, Endocrinology and Metabolism, University of Minnesota Medical School, Minneapolis, MN 55455, USA.
Postgrad Med. 1996 Jun;99(6):143-52.
Decompensated hyperglycemia is a frequent, severe complication of diabetes mellitus. Ketoacidosis usually occurs in patients with insulin-dependent (type I) diabetes, and insulin therapy is required to correct their hyperglycemic derangement. Hyperosmolar nonketotic state is more common in patients with non-insulin-dependent (type II) diabetes, who usually present with severe dehydration and hyperosmolar plasma. They respond readily to aggressive volume expansion, and insulin has a lesser role in management. Some patients exhibit a mixture of ketoacidosis and hyperosmolarity, which suggests that the two conditions may represent variants of decompensated hyperglycemia that differ only by the magnitude of dehydration and the severity of acidosis. All diabetic patients with hyperglycemic decompensation should return to their usual hypoglycemic programs as soon as possible and receive close follow-up after hospitalization.
失代偿性高血糖是糖尿病常见的严重并发症。酮症酸中毒通常发生在胰岛素依赖型（I型）糖尿病患者中，需要胰岛素治疗来纠正其高血糖紊乱。高渗非酮症状态在非胰岛素依赖型（II型）糖尿病患者中更为常见，这些患者通常表现为严重脱水和高渗血浆。他们对积极的扩容治疗反应良好，胰岛素在治疗中的作用较小。一些患者表现出酮症酸中毒和高渗状态的混合，这表明这两种情况可能代表失代偿性高血糖的不同变体，仅在脱水程度和酸中毒严重程度上有所不同。所有高血糖失代偿的糖尿病患者应尽快恢复其常规降糖方案，并在住院后接受密切随访。
