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Urgenele n Diabetul
Zaharat
As. Univ. Dr. Viviana ELIANDiabet, nutritie si boli metaboliceUMF Carol Davila, Bucuresti
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Agenda
Cetoacidoza diabetic !tarea "i#er$licemic
"i#erosmolar Acidoza lactic Coma "i#o$licemic
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CE%&ACID&'A DIABE%IC(HIPERGLICEMIE +
CETOZ +ACIDOZ METABOLIC
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FIZIOPATOLOGIA CETOACIDOZEI SEVERE
Miros daceton
respirai
cetonuri
Catabolism
proteicDefcit absolut saure
lativ de insulin
Lipoliz
Hiperglice
mie
neoglucogenez
Acidozmetaboli
chiperosmolar
iatehipovolemie
Scade fuxul sanguinrenal, cerebral,
hipoxie tisular
uree
crescut
com
AGL
iperproducie corpicetonici
cetonemie
!espiraie"#ssmaul
$tilizareperi%ericsczut aglucozei
iper " ec&hipo " ic'
glicozurie
diurezosmotic
deshidratare
hipotensiune
(ierdere de appierdere de )a,
", Ca, Cl, (, Mgpierdere de
baze tampon
aa
neoglucogenez
glicerol
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)IE*DE*I
)acient +ti#ic - / 0$ - in 12 ore3 41& 5 6,7 litri
Na8 5 26 mE9 :8 5 26 mE9
M$18
5 2; mE9 ) 5 / mMCl
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C&*)II CE%&NICI
Normal3 concentra=ie #lasmatic > ? mE9@l 1@ acid "idroibutiric i ?@ acid acetil acetic
CAD3 concentra=ii #este 7 mE9@l #n la ?7
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CAU'E
InHecii &miterea sau reducerea dozei de
insulin ManiHestare iniial a diabetului
za"arat ti# ? )atolo$ie acuta $rav3 accident
cerebrovascular acut, sindromcoronarian acut, #ancreatita acuta
%raumatismele severe
Consumul de alcool si dro$uri
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!IM)%&ME
Poliurie Polidipie !l"#i$iune Le%argie Mialgii Ce&alee Anore'ie
Grea(" )"r"%uri *uneori n ,a- de $a&ea. Dureri a#dominale /dipnee0 *repira%ie 12maul. Halen" $e%onemi$"
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EKAMEN CLINIC
Hipo%ermie Hiper3en%ila-ie *repira(ie
12maul. Halen" a$e%onemi$" De4idra%are *lim#a u$a%"5 pliu
$u%ana% peri%en%5 glo#i o$ulari4ipo%oni5 4ipo%eniune5%a4i$ardie.
O#nu#ilare5 Hipore6e'ie5
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DIAN&!%IC DIFE*ENIAL
CE%&ACID&'A ALC&&LIC(
CE%&NU*IA DE F&AME
ACID&'E ME%AB&LICE DIVE*!E acidoza lacticOacidoza renalO in$estie de salicilai, metanol,etilen$licol, #aralde"idaP
AFECQIUNI DIE!%IVE a#endicita, $astroenterita, etc.P
%ULBU*(*I *E!)I*A%&*II #neumonii severe, ICC, etc.P
C&MA
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EKAMENE DE LAB&*A%&*
Gli$emie plama%i$" PH 7 ar%erial Bi$ar#ona% eri$ Preiune CO8 9i O8 Omolari%a%e plama%i$" Corpi $e%oni$i anguini : urinari Ele$%roli-i *Na5 15 Cl.
;ree5 $rea%inina5 4emoleu$ograma ECG5 radiogra
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LAB&*A%&*
gli$emie $re$u%" $orpi $e%oni$in urin" +?++?+++
HCO@ R mE?l pH 6,S < 5@ Na+ $",u%5 normal5 $re$u% 1+ $",u%5 normal5 $re$u% Crea%inin"?uree uFor $re$u%e5
normale Leu$o$i%e uFor $re$u%e
H#5 HT5 pr %o%ale $re$u%e
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EV&LUIA !%ADIAL( A CAD U!&A*A M&DE*A%A!EVE*Alicemie T17/ m$@dl T17/ m$@dlT17/ m$@dl
)4 arterial ,17
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%*A%AMEN%
Un doctor Fi Abord venos Cateterizare vezical, sond
nazo$astric P EC Laborator Intervenie tera#eutic
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%*A%AMEN%
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%*A%AMEN%
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%*A%AMEN%
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