1、血酮監測在現代糖尿病管理中的臨床意義胰島素胰島素胰升糖素胰升糖素 脂肪分解脂肪酸丙二酸單酰CoA肉堿脂酰轉移酶I肉堿肝臟線粒體+脂肪酸氧化酮體酮體酮體生成增多的機制酮體生成增多的機制酸性代謝產物SymptomsNausea/vomitingThirst/polyuriaAbdominal painAltered mental functionShortness of breathPrecipitating eventsInadequate insulin administrationInfection (pneumonia/UTI/gastroenteritis/sepsis)Infarcti

2、on (cerebral, coronary,mesenteric, peripheral)Drugs (cocaine)Physical findingsTachycardiaDry mucous membranes/reducedskin turgorDehydration / hypotensionTachypnea / Kussmaul respirations/respiratory distressAbdominal tenderness (may resembleacute pancreatitis or surgicalabdomen)FeverLethargy /obtund

3、ation / cerebraledema / possibly 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 20

4、04;113;133-140 在美國，如果每年有10萬人因DKA住院，每人的住院費為1.3萬美元，那么每年的花費將超過10億美元*Lebovitz HE: Diabetic ketoacidosis. Lancet 345:767772, 1995*American Diabetes Association. Test of glycemia in diabetes. Diabetes Care 1999;22:s77-79酮體的三種成分1. 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.此課件