Download - Cetoacidose Diabetica 2
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COMPLICAÇÕES AGUDAS DO DIABETES
Marília Simões Bianchini
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Complicações agudas do diabetes
HIPERGLICEMIA
HIPOGLICEMIA
CETOACIDOSE DIABÉTICA
COMA HIPEROSMOLAR NÃO-CETÓTICO
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HIPERGLICEMIA
“Intensive Insulin Therapy in Critically ill Patients: Van Den Berghe, G. et cols.;
New England Journal of Medicine, Nov 2001”. Mortalidade < 40% Bacteremia < 46% Polineuropatia do doente crítico < 44% Hemotransfusão < 50% Ins. Renal Aguda (diálise ou hemofilt) < 41%
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CETOACIDOSE DIABÉTICA
Doença aguda História de diabetes insulino-dependente Evidência de fator precipitante ( infecção ) Sinais e sintomas de depleção volumétrica Manifestações clínicas de acid. metabólica Laboratório : hiperglicemia, cetonemia,
acidemia, “anion gap acidosis”
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CETOACIDOSE DIABÉTICA
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CETOACIDOSE DIABÉTICA
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CETOACIDOSE DIABÉTICA
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CETOACIDOSE DIABÉTICA
FISIOPATOLOGIA
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CETOACIDOSE DIABÉTICA
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CETOACIDOSE DIABÉTICA
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CETOACIDOSE DIABÉTICA
CETOSE E ACIDOSE METABÓLICA aumento na produção de cetoácidos diminuição do nível plasmático de HCO3 acidose hiperclorêmica acidose lática “anion gap” ( AG = Na - [ HCO3 + Cl ] ) N = 12 4 mEq / l
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CETOACIDOSE DIABÉTICA
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CETOACIDOSE DIABÉTICA
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CETOACIDOSE DIABÉTICA
DIAGNÓSTICO
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CETOACIDOSE DIABÉTICA
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CETOACIDOSE DIABÉTICA
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CETOACIDOSE DIABÉTICA
TRATAMENTO
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CETOACIDOSE DIABÉTICA Correção da hiperglicemia
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CETOACIDOSE DIABÉTICA
Correção da hiperglicemia Reposição hídrica Correção da cetose:
- Insulinoterapia Reposição eletrolítica
- Na, Cl, K, Mg, Ca, PO4 !!!! Bicarbonato de sódio ????
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CETOACIDOSE DIABÉTICA