5. 酮酸中毒的住院發生率
• 台灣:1997-2005年間
▫ 6/1,000人略微下降至5/1,000人
• 美國: 1980-2005年間
5
6萬次
12萬次
Ref:
1.台灣地區糖尿病病人酮酸中毒住院之年代趨勢以及與就醫科別間之相關性研究 劉芷菁 碩士論文 2009
2. Centers for Disease Control and Prevention: Diabetes Data & Trends (http://www.cdc.gov/diabetes/statistics/dkafirst/fig1.htm on March 1, 2011.)
6. 美國因糖尿病高血醣而死亡逐年下降
6
Ref: Centers for Disease Control and Prevention: Diabetes Data & Trends.
Retreived from http://www.cdc.gov/diabetes/statistics/dkafirst/fig1.htm on March 1, 2011.
10. 病因機轉
10
胰島素缺乏
DKA>HHS
Ref: Abbas EK. Epidemiology and pathogenesis of diabetic ketoacidosis and hyperosmolar hyperglycemic state. In: UpToDate, Jean EM (Ed),
UpToDate, Waltham, MA, 2013.
11. 有甚麼促發因子嗎?
• 胰島素不當使用或遵醫囑性差
• 新發生糖尿病(20-25%)
• 感染(30-40%),中風,心肌梗塞,藥物
DKA
• 胰島素不當使用或遵醫囑性差(21-41%)
• 感染(32-60%),中風,心肌梗塞,藥物HHS
11
Ref: Abbas EK. Epidemiology and pathogenesis of diabetic ketoacidosis and hyperosmolar hyperglycemic state. In: UpToDate, Jean EM (Ed),
UpToDate, Waltham, MA, 2013.
15. DKA和HHS中體液和電解質的流失
DKA HHS
Total water (L) 6 9
Water (ml/kg) 100 100 to 200
Na+ (mEq/kg) 7 to 10 5 to 13
Cl- (mEq/kg) 3 to 5 5 to 15
K+ (mEq/kg) 3 to 5 4 to 6
PO4 (mEq/kg) 5 to 7 3 to 7
Mg++ (mEq/kg) 1 to 2 1 to 2
Ca++ (mEq/kg) 1 to 2 1 to 2
15
Ref: Abbas EK. Clinical features and diagnosis of diabetic ketoacidosis and hyperosmolar hyperglycemic state. In: UpToDate, Jean EM (Ed),
UpToDate, Waltham, MA, 2013.