血酮监测在现代糖尿病管理中的临床意义课件.ppt

1、胰岛素胰岛素胰升糖素胰升糖素 脂肪分解脂肪酸丙二酸单酰CoA肉碱脂酰转移酶I肉碱肝脏线粒体+脂肪酸氧化酮体酮体酮体生成增多的机制酮体生成增多的机制酸性代谢产物SymptomsNausea/vomitingThirst/polyuriaAbdominal painAltered mental functionShortness of breathPrecipitating eventsInadequate insulin administrationInfection(pneumonia/UTI/gastroenteritis/sepsis)Infarction(cerebral,coronar

2、y,mesenteric,peripheral)Drugs(cocaine)Physical findingsTachycardiaDry mucous membranes/reducedskin turgorDehydration/hypotensionTachypnea/Kussmaul respirations/respiratory distressAbdominal tenderness(may resembleacute pancreatitis or surgicalabdomen)FeverLethargy/obtundation/cerebraledema/possibly

3、comaNOTE:UTI,urinary tract infection.1 Komulainen J,et al.Arch Dis Child.1996;75:4104152Rewers A,et al.JAMA.2002;287:251125183Fishbein HA,Palumbo PJ.In Diabetes in America.National Diabetes Data Group,NIH,1995,283291David B.Dunger,et al.Pediatrics 2004;113;133-140 在美国，如果每年有10万人因DKA住院，每人的住院费为1.3万美元，那

4、么每年的花费将超过10亿美元*Lebovitz HE:Diabetic ketoacidosis.Lancet 345:767772,1995*American Diabetes Association.Test of glycemia in diabetes.Diabetes Care 1999;22:s77-791.Kitabchi A,et al.Diabetic Keteoacidosis&hypoglycemic hyperosmolar non-ketotic state.In:Khan C,Weir G,eds.Joslins Diabetes Mellitus.Philadelphia:Lea and Febiger;1994:738-770.