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DZ – criterii de internare in spital*

DZ – criterii de internare in spital*. Complicatii acute severe DZ nou diagnosticat (copii/adolescenti) Control metabolic deficitar, cronic (evaluare cauza, modificare tratament) Complicatii cronice severe necesitand tratament sustinut Diabet gestational nou-descoperit sau controlat deficitar

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DZ – criterii de internare in spital*

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  1. DZ – criterii de internare in spital* • Complicatii acute severe • DZ nou diagnosticat (copii/adolescenti) • Control metabolic deficitar, cronic (evaluare cauza, modificare tratament) • Complicatii cronice severe necesitand tratament sustinut • Diabet gestational nou-descoperit sau controlat deficitar • Instituirea pompelor cu insulina sau a altor forme de terapie speciala *

  2. DZ – criterii internare: Complicatii acute* • Cetoacidoza diabetica • Glicemia > 250 mg% • Ph < 7,3 • Bicarbonat < 15 mEq/l • Ketonurie / Ketonemie • Stare hiperglicemica/hiperosmolara • Alterare neurologica • Hiperglicemie severa (> 600 mg%) • Osmolaritate crescuta (> 320 mmol/kg) *

  3. DZ – criterii internare: Complicatii acute* • Hipoglicemie severa • Glicemie < 50 mg% • Coma/convulsii/afectarea senzoriului • Hipoglicemia a fost tratata dar nu exista persoana de insotire in urmatoarele 12 h • Hipoglicemie determinata de sulfoniluree *

  4. DZ – Criterii de internare in ATI • Criterii cardio-vasculare • TAS ≤ 70 mmHg (TAM ≤ 50 mmHg) dupa resuscitare volemica corecta • Tulburari de ritm majore (Tahicardie ventriculara, Fibrilatie ventriculara) • Stop cardio-respirator resuscitat • Insuficienta respiratorie acuta • Frecventa respiratorie ≤ 8 sau ≥ 40/min • Necesitatea IOT si respiratie artificiala • SaO2≤ 85%, in respiratie spontana cu O2 pe 4 l/min masca faciala • PaCO2≥ 55 mmHg (la pacienti fara BPOC) • Coma cu Scorul Glasgow ≤ 8 • Acidoza metabolica / mixta decompensata (ph ≤ 7,1)

  5. Terapia intensiva cu Insulina – recomandari* • Pacienti critici (ATI): glicemia 80-110 mg% • Pacienti non-critici: • glicemia < 110 mg% preprandial • Glicemia <180 mg% maximum • Travaliu: glicemia 80-110 mg% * American College of Endocrinology Position Statement on Impatient Diabetic and Metabolic Control. Endocrine Practice 2004; 10 (1): 77-82

  6. Terapia intensiva cu Insulina la pacientii critici Mentinerea glicemiei in limite stranse (80-110-mg%) versus atitudinea conventionala (120-200 mg%): • ↓mortalitatea • ↓incidenta insuficientei renale dependente de dializa • ↓incidenta bacteriemiei • ↓numarului de transfuzii • ↓necesarul de ventilatie mecanica • ↓incidenta polineuropatiilor Van Den Berghe et al. Intensive insuline therapy in critically ill patients. N Engl J Med 2001; 345: 1359-1357

  7. Terapia intensiva cu Insulina la pacientii critici-Mecanisme • Mentinerea functiei macrofagelor si neutrofilelor • Efectul trofic al Insulinei pe tegumente si mucoase • Stimularea eritropoiezei si inhibarea hemolizei • Diminuarea colestazei • Efect anabolic direct al Insulinei pe muschii repiratori • Diminuarea disfunctiei axonale asociata cu hiperglicemia si deficitul de Insulina

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