diabetes ketonuria, DKA(糖尿病酮酸血症)

症狀/併發症(symptom/complication)	@lack of appetite @vomiting and @nausea 50% @polyuria: glucose resorption is not fast enough than excretion @ketonuria: in order to produce energylipolysis and produce lots of ketone @sign of dehydration: @thirst, @ @Kussmaul respiration:  a deep and labored breathing pattern @Abdominal pain: 50% complication @Cerebral edema: emergency, Mortality 20-25%, most cases is children @retinopathy: may be blind @diabetes nephropathy(糖尿病腎病變): need hemodialysis @neuropathy
病因(etiology)	|insulin deficiency |absolute glucagon raise |insulin deficiency and |inadequate fluid uptake |ischemia |iatrogenic |infection |intoxication
檢查/準則(examination/criteria)	#blood sugar> 250 mg/dl #pH< 7.3 #metabolic acid toxicity: #bicarbonate <15 mEq/l #ketone bodies examination #electrolytes: usually hypokalemia every 2~4 hours #corrected sodium:sodium increase in blood: +1.6~2.4 for every 100 mg/dl above 100
治療(treatment)	$ICU status $IV insulin: 0.1U/kg/hour, if K+<3.3, give K+ repletion, to decrease blood sugar 50~70mg/dl/hour, and blood sugar lower than 200mg/dl can add glucose to prevent hypoglycemia ( still have to supply insulin until bicarbonate >15 and changes to subcutaneous injection steps $Fluid Replacement: give 4h normal saline and then give 4h half normal saline $do not use bicarbonate to rise pH, will cause cerebral edema, except pH is lower than 7.0
鑑別診斷(Differential Diagnosis)
流行病學(Epidemiology)	+mainly occur to type I diabetes mellitus(第一型糖尿病) patients

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