Chetoacidosi
La chetoacidosi è uno scompenso metabolico acuto dovuto a deficit grave di insulina, con un tasso di mortalità del 1-2% nei centri bene attrezzati.
Può essere la prima manifestazione clinica del DM di
tipo 1, o può insorgere nel corso del suo trattamento per cause intercorrenti (stress, infezioni, infarto miocardico, interventi chirurgici) che precipitano un equilibrio stabile, o per la sospensione dell’assunzione di insulina multiniettiva o per la rottura o disconnessione del set di infusione del dispositivo per la somministrazione continua.
Il deficit grave di insulina può svilupparsi nell’arco di ore o di giorni e si associa a un aumento assoluto o relativo della secrezione di glucagone e spesso anche di altri ormoni controinsulari. Queste modificazioni ormonali determinano chetogenesi.
QUADRO CLINICO
Clinicamente la chetoacidosi esordisce con:
– astenia
-anoressia
-nausea
-vomito
-incremento della poliuria
Possono inoltre essere presenti:
– dolori addominali che simulano addome acuto.
All’esame obiettivo si può evidenziare:
– alterazione dello stato di coscienza
– confusione
– letargia
– più raramente coma profondo
Sono presenti:
– disidratazione con ipotonia del bulbi oculari
– mucose aride
– pelle secca, calda e arrossata
– alito con caratteristico odore di frutta fermentata per l’eliminazione attraverso i polmoni dell‘acetone, che ha
una bassa pressione di evaporazione.
Gli atti respiratori sono:
– rapidi e profondi (respiro di Kussmaul)
Spesso vi è:
– riduzione della pressione arteriosa che si associa a tachicardia.
Gli esami di laboratorio dimostrano:
– iperglicemia, sempre di 250 mg/dl e spesso compresa tra 400 e 700 mg/dl, con glicosuria importante.
– i corpi chetonici sono marcatamente aumentati nel sangue e nelle urine.
TERAPIA
Il trattamento della chetoacidosi diabetica deve essere tempestivo.
Gli obiettivi terapeutici sono:
– la correzione dello squilibrio metabolico, che può essere ottenuta solo somministrando insulina a dosaggi
adeguati ;
– la reintegrazione delle perdite idroelettrolitiche;
– correzione delle possibili cause scatenanti;
– la prevenzione delle complicazioni.
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