tailieunhanh - Manual of intensive care (Seventh edition): Part 2

(BQ) Continued part 1, part 2 of the document Manual of intensive care (Seventh edition) has contents: Endocrine disorders, endocrine disorders, infections and immune disorders, severe and multiple trauma, environmental injuries, pharmacologic considerations, metabolic homeostasis, and other contents. Invite you to refer. | Part Eight Endocrine Disorders 58 Diabetic Emergencies 629 59 Diabetes Insipidus and Other Polyuric Syndromes 637 60 Thyroid Emergencies 652 61 Adrenocortical Insufficiency in Critical Illness 660 62 Acute Calcium Disorders 666 This page intentionally left blank 58 Diabetic emergencies Richard Keays Diabetes mellitus is due to an absolute or relative deficiency of insulin. The sustained effect of poor glycaemic control results in a wide array of end-organ damage as a consequence of small- and large-vessel pathology. Mortality and morbidity are related to the progress of this damage but often there are acute metabolic deteriorations that can be life-threatening. Diabetic ketoacidosis DKA and hyperosmolar hyperglycaemic state HHS are two of the most common acute complications of diabetes both accompanied by hyperglycaemia. The pathophysiological changes that occur in both disease states represent an extreme example of the super-fasted state. Coma may also result from severe hypoglycaemia due to overtreatment - usually with insulin. DIABETES MELLITUS Type I insulin-dependent diabetes mellitus IDDM has a peak incidence in the young rising from 9 months to 14 years and declining thereafter. In 25 of patients the presentation is with ketoacidosis especially in those under 5 years of age. Usually the fasting plasma glucose is mmol L and glucose and ketones may be present in the urine. In the asymptomatic patient with an equivocal fasting plasma glucose an impaired glucose tolerance test may be demonstrated. Type II non-insulin-dependent diabetes mellitus NIDDM is prevalent in the elderly but can occur at any age. Truncal obesity is a risk factor and there is ethnic variation in susceptibility. Diagnosis is often delayed and may be incidental from blood or urine sugar Increasingly it is recognised that individuals can be in a prediabetic state of impaired glucose regulation for many years which makes them 5 to 15 times more likely to progress to diabetes. .