《内分泌系统疾病》糖尿病（英文）-教学课件（非AI生成）.ppt

TheTreatmentofDKAThetreatmentofDKAisveryrewardingbutfraughtwithhazardsfortheunwary.Simplemanagementprotocolarehelpfulasguidelinebutshouldbeadaptedtosuiteachindividualcase.Themajorelementsoftreatmentarefluids,insulin,potassiumandalkali.*FluidReplacement（1）Aim:correctedcellularandbloodvolumeFluidreplacementvolume：10％bodyweightcommonly(6－8litres/adultFluidreplacementsorts：initial0.9%NS(BS33.3mmol/L,Na+155mEq/L)，whenBSdecrease13.9mmol/L,infusion5％GS*FluidReplacement（2）Volumeandrapidity：thefirsthour500－1000ml2－3hours1000ml4－6hours1000mlper6－8hours1000mlafterAttention:outsideheartorrenalfailure！！Olderandweaknessinfusiondecreaseshockreplacebloodplasmahyperosmolarconditionmayinfusionhypotonicsaline*Insulin（1）6Uperhourwillproduceplasmainsulinlevelsofaround100mU/L，morethanadequatetorestrainthecatabolicprocessMethod:Insulin6U/hbyintravenousinfusionor20Uinitialthen5-6U/him.*BSdecreasespeed：decreseBS3.9-5.6mmol/L.aftertherapy2h,BShaven’trespondordecreaseslowly(basevolume1/3),RIincreaseproperlydoseBloodglucose13.9mmol/Llevels,relativestabilizeadvantage：?preventhypoglyceamia?preventordecreasehydrocephalus?preventBloodpressure↓Insulin（2）*Potassium:Potassiumlevelsmaybelow,normalorhighatpresentationofDKA,despiteatotalbodydeficitof300-1000mmol.?After4-6hourstreatment,potassiumdecreaseobviously.?Firstdayreplacepotassium6.0－8.0g?Urine30ml/h,potassium5.0mEq/L,nottemporilyreplacepotassiumAttend:bloodSoduum,chlorinebalanceCorrectElectrolytes*CorrectAcidosisReplacealkaliindicate：pH7.0-7.1CO2CP4.5-6.7mmol/LHCO3-5mmol/LReplacealklidose:5%sodiumbicarbonateml＝(normarylyCO2CP(50vol%)-determinevolum)×0.5×bodyweight(kg)accordingto1/3～1/2beestimatedvolume