ACUTE COMPLICATIONS OF DIABETES MELLITUS：糖尿病急性并发症.ppt

ACUTE COMPLICATIONS OF DIABETES MELLITUS Department of Internal Medicine №2 as.- prof. Martynyuk L.P. Plan of lecture Diabetic ketoacidisis Precipitating factors Signs, symptoms, physical examination, laboratory findings Treatment Nonketonic hyperglycemic-hyperosmolar coma Precipitating factors Signs, symptoms, physical examination, laboratory findings Treatment Lactoacidosis Precipitating factors Signs, symptoms, physical examination, laboratory findings Treatment Hypoglycemic coma Precipitating factors Signs, symptoms, physical examination, laboratory findings Treatment Classification of acute complications of DM 1. Diabetic coma: 1) ketosis→diabetic ketoacidisis (DKA) 2) nonketonic hyperglycemic-hyperosmolar coma (NKHHC) 3) lactoacidosis (LA) 2. Hypoglycemic coma (HC) Precipitating factors of DKA 1. newly diagnosed diabetes (presenting manifestation); 2. inadequate administration of exogenous insulin; 3. increased requirements for insulin caused by the presence of an underlying stressful condition: an intercurrent infection (pneumonia, cholecyctitis); a vascular disorder (myocardial infarction, stroke); an endocrine disorder(hyperthyroidism, pheochromocytoma); trauma; pregnancy; surgery Treatment The goals of therapy include: Reduction of hyperglycemia Rehydratation Correction of electrolyte imbalance Correction of acid-base imbalance Investigation of precipitating factors, treatment of complications. Nonketonic hyperglycemic-hyperosmolar coma (NKHHC or HNC). HNC is a syndrome characterized by impaired consciousness, sometimes accompanied by seizures, extreme dehydration, , and extreme hyperglycemia that is not accompanied by ketoacidosis. Predisposing factors HNC seems to occur spontaneously in about 5 – 7 % of patients. Infection (e.g., pneumonia, urinary tract infection, gram-negative sepsis) is underlying frequent precipitating cause. Use of certain drugs has been associated with this condition: steroids increase glucogenesis and