Crisis de hiperglicemia en pacientes adultos con diabetes
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Crisis de hiperglicemia en pacientes adultos con diabetes

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CRISIS HIPERGLICEMIAS EN DM

CRISIS HIPERGLICEMIAS EN DM

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Crisis de hiperglicemia en pacientes adultos con diabetes Crisis de hiperglicemia en pacientes adultos con diabetes Presentation Transcript

  • Crisis de hiperglicemia en pacientes adultos con Diabetes Mellitus
    MARIA ALEJANDRA ENRIQUEZ
    R I MEDICINA INTERNA FUSM
  • Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.
    Crisis de hiperglicemia en DM
  • CRITERIOS DIAGNOSTICOS PARA CAD Y HHS
    Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.
  • Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.
    Crisis de Hiperglicemia en DMEpidemiologia
  • Patogenesis
    Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.
  • Patogenesis
    Kitabchi, Abbas E; Epidemiology and pathogenesis of diabetic ketoacidosis and
    Hyperosmolar hiperglycemic state, Agosto 2009
  • Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.
  • Factoresprecipitantes
    Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.
  • Factores precipitantes
    Data from: Kitabchi, AE, Umpierrez, GE, Murphy, MB, et al. Management of hyperglycemic crises in patients with diabetes mellitus (Technical Review). Diabetes Care 2001; 24:131
  • Factores precipitantes
    Data from: Kitabchi, AE, Umpierrez, GE, Murphy, MB, et al. Management of hyperglycemic crises in patients with diabetes mellitus (Technical Review). Diabetes Care 2001; 24:131
  • CAD desarrollo rápido, 24-horas, dolor abdominal y respiración Kussmaul
    HHS insidiosa, con poliuria, polidipsia y pérdida de peso, varios días antes de su ingreso.
    Sintomas neurológicos progresivos
    incluyendo letargo, signos focales, y obnubilación, progresar a coma en etapas posteriores
    Presentación Clínica
    Kitabchi Abbas, Clinical Features and Diagnosis of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults Enero 2010, Uptodate
  • Osmolaridad elevada causa alt. Neurológicas.
    >320 mmol/kg
    Osmolaridad efectiva= 2Na + glucemia/18
    urea no induce cambios intracelulares en volumen o el gradiente osmótico de la membrana celular
    Diuresis osmótica, perdida de agua Na Y K.
    Osmolaridad normal, y sx neurológicos obliga a buscar otras causas
    Presentación clínica
    Kitabchi Abbas, treatment of diagnosis of Diabetic Ketoacidosis and Hyperosmolar Hyperglicemic state in adults Enero 2010, Uptodate
  • Dolor abdominal, En CAD 40%, en relación con severidad de acidosis
    Se relaciona con HCO3 5-15
    Lento vaciamiento gástrico
    Desequilibrio H – Electrolítico
    Si persiste post a resolución de CAD buscar otras causas.
    Presentación clínica
    Kitabchi Abbas, Clinical Features And diagnosis of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic state in adults, Jan 2010, Uptodate.
  • Hallazgos de Laboratorio
    Diabetes Care, American Diabetes Association, July 2009
  • Hallazgos de laboratorio
    Kitabchi Abbas, Clinical features and diagnosis of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.
  • Hallazgos de laboratorio
    Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.
  • La gravedad de acidosis metabólica depende
    La tasa de producción de cetoacidos.
    La duración de la producción cetoácido
    Tasa de excreción urinaria. ( depende funcion renal)
    El anión gap: Estimación de la cantidad de aniones no medidos en suero
      
     anion gap = Na sérico - (Cl + HCO3)
    Hallazgos de Laboratorio
    Kitabchi Abbas, Clinical Features and diagnosis of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults,
    Jan 2009, Uptodate.
  • Hallazgos de Laboratorio
    Kitabchi Abbas, Features and diagnosis of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Jan 2009, Uptodate.
  • Hallazgos de Laboratorio
    Kitabchi Abbas, Clinical Features and diagnosis of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Jan 2009, Uptodate.
  • Hallazgos de laboratorio
    • amilasa y lipasa, aumentada si pancreatitis causa de CAD
    • Para diagnostico de pancreatitis basarse en clínica
    • Puede elevarse amilasa por producción en glan. salivares
    Kitabchi Abbas, Clinical Features and diagnosis of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Jan 2009, Uptodate.
  • Hallazgos de Laboratorio
    Kitabchi Abbas, Clinical Features and diadnosis of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Jan 2009, Uptodate.
  • Tratamiento
    Evaluación inicial examen físico deben centrarse en:
    Vía aérea, respiración y circulación (ABC)
    Estado mental
    Posibles factores precipitantes
    Estado de hidratación y volemia
    La evaluación inicial de laboratorio:
    Glucosa sérica
    Electrolitos (con cálculo del anión gap), Azoados
    Hemograma completo con diferencial
    Uroanálisis y cetonas en la orina con tira reactiva
    Osmolaridad de plasma
    Cetonas en suero
    Gases arteriales Electrocardiograma
    Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.
  • Tratamiento
    Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.
  • Tratamiento
    Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.
  • Tratamiento
    Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.
  • Tratamiento
    Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.
  • Tratamiento
    Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.
  • Tratamiento
    Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.
  • Tratamiento
    Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct 2009, Uptodate.
  • Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Jan. 2009, Uptodate.
    Kitabchi Abbas, treatment of Diabetics Ketoacidosis and Hyperosmolar Hyperglicemic State in adults, Oct. 2009, Uptodate.
    Diabetes Care, American Diabetes Association, July 2009
    Bibliografia