Factores predisponentes para cetoacidosis diabética estudio a realizarse en el Area de Hospitalización del Hospital Universitario de Guayaquil en el período 2014 - 2015
Fecha
2016
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Carrera de Medicina
Resumen
Se debe a la deficiencia de insulina asociada al aumento de las hormonas
contrareguladoras como el glucagon, cortisol, adrenalina y hormona de crecimiento.
Esto genera un aumento de la producción hepática y renal de glucosa y uso irregular
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de glucosa en los tejidos periféricos resultando en hiperglucemia y cambios paralelos
en la osmolaridad del espacio extracelular. Se produce liberación de ácidos grasos a la
circulación (por lipólisis) con la oxidación concomitante de estos a cuerpos cetónicos
(Beta hidroxi-butírico y acetoacetato) resultando en cetonemia y acidosis metabólica.
la cetoacidosis diabética y el estado hiperglicémico hiperosmolar son las dos
complicaciones metabólicas más graves de la diabetes. Estas enfermedades aparecen
tanto en los pacientes con diabetes tipo 1 como en la tipo 2 y ocurren durante estrés
catabólico o enfermedades agudas severas. La tasa de mortalidad en pacientes con
cetoacidosis diabética es del 5% mientras que la tasa de mortalidad del estado
hiperglicémico hiperosmolar es de aproximadamente el 11%. Como prioridad en todo
paciente que ingresa al servicio de urgencias se tendrá en cuenta el ABC en la
evaluación inicial con medidas de soporte, monitorización y acceso venoso. Las metas
terapéuticas en la cetoacidosis diabética se dirigen hacia la corrección de la
deshidratación para mejorar el volumen circulante, la administración adecuada de
insulina y el reemplazo de potasio. La administración de bicarbonato, fosfato,
magnesio u otras terapias puede ser ventajosa en algunos pacientes, pero no se deben
considerar como la primera línea de manejo. Luego de la estabilización del paciente es
muy importante el tratamiento basado en la educación para reconocer
oportunamente una descompensación, tratando de llevar siempre al paciente a una
prevención de eventos posteriores.
It is due to insulin deficiency associated with increased counterregulatory hormones such as glucagon, cortisol, adrenaline and growth hormone. This leads to increased renal and hepatic glucose production and irregular use of glucose in peripheral tissues resulting in hyperglycemia and parallel changes in osmolarity of the extracellular space. release of fatty circulation (lipolysis) with the concomitant oxidation of these to ketone bodies (Beta-hydroxy butyric and acetoacetate) resulting in metabolic acidosis and ketonemia acids occurs. diabetic ketoacidosis and hyperosmolar hyperglycemic state are the two most serious metabolic complications of diabetes. These diseases occur both in patients with type 1 diabetes and type 2 and occur during catabolic stress or severe acute illness. The mortality rate in patients with diabetic ketoacidosis is 5% while the mortality rate of hyperosmolar hyperglycemic state is approximately 11%. As a priority in all patients entering the emergency department will take into account the ABC in the initial evaluation with supportive measures, monitoring and venous access. The therapeutic targets in diabetic ketoacidosis head towards the correction of dehydration to improve circulating volume, the proper administration of insulin and potassium replacement. The administration of bicarbonate, phosphate, magnesium or other therapies may be advantageous in some patients but should not be considered as the first line management. After stabilizing the patient is very important based education to timely recognize decompensation, always trying to take the patient to a treatment preventing subsequent events.
It is due to insulin deficiency associated with increased counterregulatory hormones such as glucagon, cortisol, adrenaline and growth hormone. This leads to increased renal and hepatic glucose production and irregular use of glucose in peripheral tissues resulting in hyperglycemia and parallel changes in osmolarity of the extracellular space. release of fatty circulation (lipolysis) with the concomitant oxidation of these to ketone bodies (Beta-hydroxy butyric and acetoacetate) resulting in metabolic acidosis and ketonemia acids occurs. diabetic ketoacidosis and hyperosmolar hyperglycemic state are the two most serious metabolic complications of diabetes. These diseases occur both in patients with type 1 diabetes and type 2 and occur during catabolic stress or severe acute illness. The mortality rate in patients with diabetic ketoacidosis is 5% while the mortality rate of hyperosmolar hyperglycemic state is approximately 11%. As a priority in all patients entering the emergency department will take into account the ABC in the initial evaluation with supportive measures, monitoring and venous access. The therapeutic targets in diabetic ketoacidosis head towards the correction of dehydration to improve circulating volume, the proper administration of insulin and potassium replacement. The administration of bicarbonate, phosphate, magnesium or other therapies may be advantageous in some patients but should not be considered as the first line management. After stabilizing the patient is very important based education to timely recognize decompensation, always trying to take the patient to a treatment preventing subsequent events.
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Diabetes mellitus, Glucemia, Cetoacidosis diabética, Hospital Universitario de Guayaquil, Cantón Guayaquil, Ecuador, Causalidad