medicina55巻10号

2018年09月発行

特集 クリティカル・ケアを極める—一歩進んだ総合内科医を目指して 内科クリティカル・ケア実践編─このパターンを押さえれば8割は対応可能

高血糖緊急症のマネジメント

著者： 上田剛士¹

所属機関： ¹洛和会丸太町病院総合診療科

ページ範囲：P.1566 - P.1569

Point
◎補液は生理食塩水もしくはリンゲル液で循環不全を改善するように十分量投与するが，補液過多に注意する．
◎血糖は50〜70mg/dL/時で低下することが多いが，有効血清浸透圧の変化は最小限にとどめる．
◎血糖が200〜300mg/dLとなれば糖を補充しインスリン量を減ずる．
◎Kの補正は重要だが，アシドーシスと低P血症の補正の必要性には議論がある．

参考文献

1）Kitabchi AE, et al：Management of hyperglycemic crises in patients with diabetes. Diabetes Care 24：131-153, 2001

2）English P, Williams G：Hyperglycaemic crises and lactic acidosis in diabetes mellitus. Postgrad Med J 80：253-261, 2004

3）Basnet S, et al：Effect of normal saline and half normal saline on serum electrolytes during recovery phase of diabetic ketoacidosis. J Intensive Care Med 29：38-42, 2014

4）Van Zyl DG, et al：Fluid management in diabetic-acidosis─Ringer's lactate versus normal saline；A randomized controlled trial. QJM 105：337-343, 2012

5）Yung M, et al：Controlled trial of Hartmann's solution versus 0.9％ saline for diabetic ketoacidosis. J Paediatr Child Health 53：12-17, 2017

6）Wiggam MI, et al：Treatment of diabetic ketoacidosis using normalization of blood 3-hydroxybutyrate concentration as the endpoint of emergency management. A randomized controlled study. Diabetes Care 20：1347-1352, 1997

7）Kitabchi AE, et al：Hyperglycemic crises in adult patients with diabetes. Diabetes Care 32：1335-1343, 2009

8）Hoorn EJ, et al：Preventing a drop in effective plasma osmolality to minimize the likelihood of cerebral edema during treatment of children with diabetic ketoacidosis. J Pediatr 150：467-473, 2007

9）Glaser NS, et al：Correlation of clinical and biochemical findings with diabetic ketoacidosis-related cerebral edema in children using magnetic resonance diffusion-weighted imaging. J Pediatr 153：541-546, 2008

10）Beigelman PM：Severe diabetic ketoacidosis（diabetic “coma”）．482 episodes in 257 patients；Experience of three years. Diabetes 20：490-500, 1971

11）Soler NG, et al：Potassium balance during treatment of diabetic ketoacidosis with special reference to the use of bicarbonate. Lancet 2：665-667, 1972

12）Owen OE, et al：Human splanchnic metabolism during diabetic ketoacidosis. Metabolism 26：381-398, 1977

13）Fisher JN, Kitabchi AE：A randomized study of phosphate therapy in the treatment of diabetic ketoacidosis. J Clin Endocrinol Metab 57：177-180, 1983

14）Hasselstrøm L, et al：Hypophosphatemia and acute respiratory failure in a diabetic patient. Intensive Care Med 12：429-431, 1986

15）Liu PY, Jeng CY：Severe hypophosphatemia in a patient with diabetic ketoacidosis and acute respiratory failure. J Chin Med Assoc 67：355-359, 2004

16）Kutlu AO, et al：Rhabdomyolysis without detectable myoglobulinuria due to severe hypophosphatemia in diabetic ketoacidosis. Pediatr Emerg Care 27：537-538, 2011

17）Shilo S, et al：Acute hemolytic anemia caused by severe hypophosphatemia in diabetic ketoacidosis. Acta Haematol 73：55-57, 1985