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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%