11-curs urgente dz

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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 > ? [email protected] [email protected] acid "idroibutiric i [email protected] acid acetil acetic

    CAD3 concentra=ii #este 7 [email protected] #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" +?++?+++

    [email protected] R mE?l pH 6,S < [email protected] 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/ [email protected] T17/ [email protected]/ [email protected]

    )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%