高血糖危象之定義與處置

Definition and Management of Hyperglycemia Crisis

張淑玲(Shu-Ling Chang) ； 王郁青(Yu-Chin Lily Wang)

《臺灣臨床藥學雜誌》 28卷3期 (2020/07) Pp. 177-184

https://doi.org/10.6168/FJCP.202007_28(3).0002

摘要

高血糖危象不僅在急性期增加死亡風險，一旦發展成糖尿病酮症酸中毒（diabetic ketoacidos, DKA）或高滲透壓高血糖狀態（hyperosmolar hyperglycemic state, HHS）也會增加長期死亡的風險。區分兩者的診斷依據包括：高血糖程度、酮酸中毒發生與否及滲透壓變化等。儘管HHS病人血糖濃度及滲透壓變動程度比DKA病人劇烈，但DKA病人卻常發生代謝性酸中毒，這是兩者臨床表現上的差異也是兩者的鑑別指標。高血糖危象是一種緊急狀況，若早期診斷不當很可能影響治療結果。儘管DKA和HHS病人臨床處置相似，像是給予胰島素、校正體液及電解質異常等，但DKA治療時可能會發生酮酸蓄積，因此必須確認病人是否已發生酸中毒，甚至需考慮是否給予碳酸氫鹽以糾正酸中毒情況，這與以超高血糖為臨床表現的HHS患者不同。雖然DKA與HHS病人都會出現高血糖，但表現程度卻有顯著落差。本文引用英國及美國指南對DKA或HHS這兩種疾病狀態的處置建議，試圖深入探討兩者差異及處置時的注意事項，希望能有助於釐清這兩種高血糖危象的特性並提供有用資訊，使臨床人員在危急處置時能做出正確處置，儘快化解高血糖危機。

關鍵字

高血糖危象 ； 糖尿病酮症酸中毒 ； 高滲透壓高血糖狀態

並列摘要

Hyperglycemia crises increased not only the risk of death in the acute phase but also the risk of long-term mortality once they developed into diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). The diagnosis to distinguish DKA and HHS was based on the degree of hyperglycemia, the development of ketoacidosis, and the change of osmotic pressure. Although the variability of blood glucose levels and osmotic pressure in HHS patients was more significant, metabolic acidosis was more common in DKA patients. Those were the differences in clinical manifestations between DKA and HHS patients. The hyperglycemia crisis was an emergency condition when inappropriate diagnosis happened at an early stage, it may affect the therapeutic outcomes. Despite the fact that the clinical treatment between DKA and HHS patients were similar, such as insulin administration, correction of fluids, and electrolyte abnormalities, ketoacid accumulation may occur during DKA treatment. Therefore, it was necessary to confirm whether the patient had developed acidosis, and even consider whether giving bicarbonate to correct acidosis. It differed from HHS patients who had hyperglycemia as a clinical manifestation. Although both DKA and HHS patients had hyperglycemia, there was a significant difference. In this article, we will discuss the differences according to the UK and USA guidelines for the management of DKA and HHS. We try to discuss the differences and precautions between DKA and HHS patients. And we hope to distinguish these two types of hyperglycemic crises and provide useful information to clinical staff to give the right treatment as soon as possible when they handle a critical condition.

並列關鍵字

Hyperglycemic Crises ； Diabetic Ketoacidosis ； Hyperosmolar Hyperglycemic State