•
드물다
- glycosuria and osmotic diuresis가 없으므로
- 탈수와 쇼크상태에서 보호
- Hyperkalemia and metabolic acidosis는 보일 수 있다
•
Volume loss는 발생할 수 있다
- 장기간 경구 첩취량 감소 시
- 불감성 수분손실이 느는 경우 (발열, 빈호흡)
- 투석환자 DKA 가이드라인은 아직 없다
D1. 치료
(1) Hyperosmolar state
•
Gradual correction of hyperosmolar state
- Avoid fatal complication, Cerebral edema, pontine myelinolysis
- Check level of consciousness
•
Hypertonicity → improve with insulin infusion
Recommended target rate: 50-75mg/dL/hr
•
Emergency HD → extreme tonicity change
(2) Volume status
•
Fluid resuscitation with bolus 250-500mL
•
Euvolemic/hypervolemic status: No fluid required ⇒ 아닌데….
•
Continuous re-evaluation of volume status
(3) Insulin infusion
•
Start insulin infusion 0.05-0.07unit/kg/hr (신부전 아닌 환자의 절반 정도 수준)
Prevent sudden change in osmolality and hypoglycemia
(4) Potassium replacement
•
Usually hyperkalemic
•
Only K+<3.5
(5) Metabolic acidosis
•
Bicarbonate is not recommended
Emergent hemodialysis is needed
•
Emergent HD
Severe pulmonary edema
Severe metabolic acidosis
Severe hyperkalemia
•
CRRT
Slow solute clearance per unit
More appropriate in patient with hemodynamic instability
