Diyabetik ketoasidozda tanı ve tedavi yaklaşımı

Yıl 2019, Cilt: 2 Sayı: 3, 92 - 98, 01.07.2019

Tuna Turan , İrfan Karahan , Aşkın Güngüneş

https://doi.org/10.32322/jhsm.452023

Öz

Diyabetik
ketoasidoz,   hızlı tanı ve tedavi
gerektiren tip 1 ve tip 2 diyabetes mellitusun ciddi komplikasyonlarından
biridir.  Genellikle tip 1 diyabet ile
birlikteliği vardır. Bunun yanında tip 2 diyabet hastalarında katabolik strese
yol açan ciddi enfeksiyon, travma, kardiyovasküler veya diğer acil durumlarda diyabetik
ketoasidoz tablosu görülebilir. Hiperglisemi osmotik diüreze yol açar. Osmotik diürez
elektrolitten çok sıvı kaybı ile karakterizedir.  İntravasküler hacim azalır. Bu durum
ilerledikçe böbrek perfüzyonu azalır, idrarla glukoz atılımı azaltılır,
hiperosmolarite giderek artar. Hiperozmolarite >330 mOsm/kg’ı aşarsa merkezi
sinir sistemi depresyonu ve koma durumu ortaya çıkabilir. Tanının erken konulup
tedaviye hemen başlanması mortalitede ciddi oranda azalmalara yol açmaktadır.
Tedavide en önemli sıvı replasmanı, sonra insülin tedavisi ve ardından
ketoasidoza yol açan nedene yönelik tedavidir. Diyabet sıklığı giderek artmakta
olduğu için, her hekimin pratikte karşılaşabileceği ve mortal seyredebilecek bu
komplikasyona dikkat çekmek istedik.

Anahtar Kelimeler

Diyabet, ketoasidoz, komplikasyon

Diagnostic and therapeutic approach to diabetic ketoacidosis

Öz

Diabetic
ketoacidosis is one of the serious complications of type 1 and type 2 diabetes
mellitus which require prompt diagnosis and treatment. It is usually associated
with type 1 diabetes. In addition, diabetic ketoacidosis can occur in severe
infection, trauma, cardiovascular or other emergencies that lead to catabolic
stress in type 2 diabetic patients. Hyperglycaemia leads to osmotic diuresis.
The osmotic diuresis is characterized by very fluid loss from the electrolyte.
The intravascular volume is reduced. As this condition progresses, kidney perfusion
decreases, urinary glucose excretion decreases, hyperosmolarity progressively
increases. If hyperosmolarity exceeds 330 mOsm / kg, central nervous system
depression and coma may occur. The early introduction of the diagnosis and the
onset of treatment immediately lead to a serious decrease in mortality.
Treatment is the most important fluid replacement, followed by insulin therapy
followed by treatment for ketoacidosis. As the frequency of diabetes is
increasing, we would like to draw attention to this complication that every
physician may encounter in practice and in mortality.

Anahtar Kelimeler

Diabetes, ketoasidosis, complication

Kaynakça

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