Page 133 - Phòng Và Điều Trị Bệnh Đái Tháo Đường
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Bang 10: Chan doan phan biet
                           cac dang hon me DTD khac nhau

                                    Hon me toan          Hon me tang
                                        ceton          dp life tham thau

                  Dtfdng mau       > 300mg/dl         > 600mg/dl
                                   (16,7mmol/l)       (33,3mmol/l)
                   S         If
                  Ap ltfc tham  < 320 mosm/kg         > 320mosm/kg
                  thau

                  pH mau           < 7,2              binh thtfdng (hay gap)
                  Kiem dtf         <-20               binh thtfdng (hay gap)
                  Ceton nieu       +++                Hiem khi +

                    - Xet nghiem bo sung:

                    . Phosphat.

                    . Lipase, CPK, Ca++, transaminase, TSH cd sd.
                    . Dien tim, XQ phoi.

                    .  Chan  doan  phan  biet:  hon  me  do  cac  nguyen
                 nhan khac.
                    Dieu tri

                    o  Theo  doi  tai  khoa  dieu  tri  tang  ctfdng:  dat
                 monitor,  theo  doi  chat  che  huyet  ap,  dat  catheter
                 tinh  mach  trung  tam,  do  ap  ltfc  tinh  mach  trung
                 tam,  lam cac xet nghiem can thiet, co the dat sonde

                 da day,  thd oxy.
                                  v              /t   O             /
                    o Bu ntfdc: bang dich muoi dang thtfdng; neu Na+ >
                 155mmol/l: bit dau bang NaCl 4,5%o. Khi dtfdng mau
                 <  250mg/dl  (13,9mmol/l),  thay  the  dich  muoi  ding



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