Diabetic patients, under the influence of various triggers, experience a significant deficiency of insulin and an inappropriate increase in glucose-raising hormones, leading to pathological changes such as hyperglycemia, high blood ketones, ketonuria, dehydration, electrolyte imbalance, and metabolic acidosis. This is one of the common medical emergencies.

bubble_chart Diagnosis

1. Medical History and Symptoms

Seen in type 1 diabetes; with triggers such as infection, stress, improper diet, interruption of insulin; presenting with polydipsia and polyuria, lack of strength, decreased appetite, nausea, vomiting, accompanied by headache, drowsiness, dysphoria, and other symptoms.

2. Physical Examination

Flushed skin, deep and rapid breathing, possible fruity odor in breath; severe cases may present with dehydration and unconsciousness.

3. Auxiliary Examinations

Positive for urine glucose and urine ketones; elevated blood glucose (16.7～33.3mmol/L); elevated white blood cell count (infection or dehydration); increased BUN, decreased CO2 combining power and pH, electrolyte disturbances. 4. Differential Diagnosis Should be differentiated from cerebral hemorrhage, poisoning, and diabetic unconsciousness (refer to other chapters).

bubble_chart Treatment Measures

1. Immediate rehydration:

Use normal saline, and the rehydration volume can be estimated at 10% of the original body weight; when blood glucose drops to 13.9mmol/L, switch to 5% glucose solution.

2. Intravenous insulin infusion:

Add insulin to the fluid, and continuously infuse at a small dose of 0.1U/Kg.h; before ketone bodies disappear, the insulin dosage is 4～6U/h, allowing blood glucose to drop by 3.9～5.6mmol/L per hour; after ketone bodies disappear, the insulin dosage is 2～3U/h, maintaining blood glucose at 13.9mmol/L to avoid hypoglycemia and cerebral edema.

Potassium loss is severe in ketoacidosis, and potassium can be supplemented as soon as urine is seen, and it should be fully replenished within 4～6 days. Generally, alkali is not actively supplemented, when PH <7.1，CO ₂ CP <8.984mmol/L時才補鹼，可用5%NaHCO ₃ solution, 0.5ml/Kg, increases the carbon dioxide combining power by 0.449mmol/L.

4. Treat complications such as cerebral edema, arrhythmia, heart failure, gastrointestinal bleeding, etc.

5. Admit to the ward immediately once vital signs are stable.