DIYABETIK KETOASIDOZ PDF

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Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe. In severe DKA, breathing becomes rapid and of a deep, gasping character, called " Kussmaul breathing ". If the dehydration is profound enough to cause a decrease in the circulating blood volume, a rapid heart rate and low blood pressure may be observed.

Often, a "ketotic" odor is present, which is often described as "fruity" or like "pear drops". It occurs in about 1 out of children with DKA and more rarely occurs in adults. There is often a particular underlying problem that has led to the DKA episode; this may be intercurrent illness pneumonia , influenza , gastroenteritis , a urinary tract infection , pregnancy , inadequate insulin administration e. Young people with recurrent episodes of DKA may have an underlying eating disorder , or may be using insufficient insulin for fear that it will cause weight gain.

Their condition is then labeled "ketosis-prone type 2 diabetes". Furthermore it can be triggered by severe acute illness, dehydration, extensive exercise, surgery, low-carbohydrate diets, or excessive alcohol intake. Specifically, they should not be used if someone is also using a low carbohydrate or ketogenic diet.

The lack of insulin and corresponding elevation of glucagon leads to increased release of glucose by the liver a process that is normally suppressed by insulin from glycogen via glycogenolysis and also through gluconeogenesis. High glucose levels spill over into the urine, taking water and solutes such as sodium and potassium along with it in a process known as osmotic diuresis.

The ketone bodies, however, have a low pKa and therefore turn the blood acidic metabolic acidosis. The body initially buffers the change with the bicarbonate buffering system , but this system is quickly overwhelmed and other mechanisms must work to compensate for the acidosis. This hyperventilation, in its extreme form, may be observed as Kussmaul respiration.

Blood sugars rise, dehydration ensues, and resistance to the normal effects of insulin increases further by way of a vicious circle. Glucose levels usually exceed DKA is common in type 1 diabetes as this form of diabetes is associated with an absolute lack of insulin production by the islets of Langerhans.

Usually, these amounts of insulin are sufficient to suppress ketogenesis. If DKA occurs in someone with type 2 diabetes, their condition is called "ketosis-prone type 2 diabetes".

Some authorities suggest that it is the result from overvigorous fluid replacement, but the complication may develop before treatment has been commenced.

Furthermore, markers of infection complete blood count , C-reactive protein and acute pancreatitis amylase and lipase may be measured. Given the need to exclude infection, chest radiography and urinalysis are usually performed. It may also result from alcohol excess and from starvation ; in both states the glucose level is normal or low.

Metabolic acidosis may occur in people with diabetes for other reasons, such as poisoning with ethylene glycol or paraldehyde. Instructions include advice on how much extra insulin to take when sugar levels appear uncontrolled, an easily digestible diet rich in salt and carbohydrates, means to suppress fever and treat infection, and recommendations when to call for medical help. Admission to an intensive care unit ICU or similar high-dependency area or ward for close observation may be necessary.

This situation requires ICU admission, monitoring of the central venous pressure which requires the insertion of a central venous catheter in a large upper body vein , and the administration of medication that increases the heart pumping action and blood pressure.

This can be administered immediately after the potassium level is known to be higher than 3. Guidelines differ as to which dose to use when blood sugar levels start falling; some recommend reducing the dose of insulin once glucose falls below A large part of the shifted extracellular potassium would have been lost in urine because of osmotic diuresis. Hypokalemia low blood potassium concentration often follows treatment.

This increases the risk of dangerous irregularities in the heart rate. Therefore, continuous observation of the heart rate is recommended, [23] as well as repeated measurement of the potassium levels and addition of potassium to the intravenous fluids once levels fall below 5. If potassium levels fall below 3. The administration of fluids is slowed.

Once this has been achieved, insulin may be switched to the usual subcutaneously administered regimen, one hour after which the intravenous administration can be discontinued. There has been a documented increasing trend to hospital admissions.

It was initially thought to be a form of maturity onset diabetes of the young , [32] and went through several other descriptive names such as "idiopathic type 1 diabetes", "Flatbush diabetes", "atypical diabetes" and "type 1.

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