Cắt túi mật cho bệnh nhân có triệu chứng không rõ ràng Hướng dẫn cho trẻ em bằng phẫu thuật không có triệu chứng sỏi mật cần thiết để | Chapter 10 Endocrine Disorders 199 Ketoacidosis Essentials of Diagnosis Ketonemia defined as blood ketone P-hydroxy butyrate 1 mM L with hyperglycemia Ketoacidosis defined as venous pH with hyperglycemia and ketonemia Symptoms of ketoacidosis dehydration fever vasodilation hyperglycemia Kussmaul respiration neurologic signs of cerebral edema lethargy headache dilated pupils severe abdominal pain usually a result of hepatic swelling Cerebral edema may result from ketoacidosis or may be secondary to overhydration with hypotonic fluids Differential Diagnosis Drug-induced hyperglycemia ketosis rare steroids thiazides minoxidil diazoxide P-blockers Glucagon-secreting tumors elevate blood sugar ketosis rare Hyperthyroidism fever stress elevate blood sugar ketosis rare Patients with type 2 diabetes may be hyperglycemic enough to have hyperosmotic symptoms without ketosis Alcoholic ketoacidosis occurs with sudden alcohol withdrawal. Rare in children Extremely high fat diet or starvation causes ketosis with normo-glycemia The abdominal pain associated with ketoacidosis may suggest a surgical abdomen especially appendicitis Treatment Principles of therapy in ketoacidosis restore fluid volume inhibit lipolysis restore normal glucose utilization using insulin correct total body sodium and potassium depletion correct acidosis prevent or treat cerebral edema Ketonemia without acidosis give 10-20 of total daily insulin dose subcutaneously H NL or regular insulin every 2-3 hours with oral fluids until ketonuria resolves Caution must be exercised in treating fluid deficits in diabetic ketoacidosis to avoid hyponatremia and cerebral edema Pearl Hypocalcemia can occur during treatment of diabetic ketoacidosis if all IVpotassium is given as potassium phosphate. Hypophosphatemia results if no potassium phosphate is given. Use 50 potassium chloride or acetate and 50 potassium phosphate. 10 This page intentionally left blank -------11------------ Inborn Errors of Metabolism Glycogen
