# 將每項發現拖曳至其最強烈支持的急性葡萄糖急症。 > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=393522&lang=zh-tw > language: zh-TW > subject: Medical Emergencies > category: PA ## 題目 將每項發現拖曳至其最強烈支持的急性葡萄糖急症。 **1.** 血糖 710 mg/dL，有效滲透壓 326 mOsm/kg，beta-hydroxybutyrate 1.5 mmol/L，pH 7.36 Select a category DKA HHS Hypoglycemia **2.** 血糖 238 mg/dL，beta-hydroxybutyrate 4.2 mmol/L，碳酸氫鹽 14 mmol/L，pH 7.24 Select a category DKA HHS Hypoglycemia **3.** 使用 SGLT2 抑制劑，血糖 178 mg/dL，beta-hydroxybutyrate 4.0 mmol/L，pH 7.25 Select a category DKA HHS Hypoglycemia **4.** 盜汗、震顫和心悸，血糖 54 mg/dL Select a category DKA HHS Hypoglycemia **5.** 老年個案嚴重脫水，血糖 680 mg/dL，高滲透壓，且進行性意識混亂 Select a category DKA HHS Hypoglycemia **6.** 意識混亂，血糖 38 mg/dL，在給予處方靜脈葡萄糖後迅速改善 Select a category DKA HHS Hypoglycemia ## 解析 DKA 需要糖尿病或血糖至少 200 mg/dL，同時伴有顯著酮血症和代謝性酸中毒；正常血糖性 DKA 可能發生，特別是使用 SGLT2 抑制劑時。HHS 需要明顯的高血糖和高滲透壓，且無嚴重酮血症或酸中毒，但可能存在輕度酮血症。低血糖會產生自律神經或神經低血糖性發現，在葡萄糖治療後會改善。 ## 深入解析 快速解答 DKA = 酮體加上酸中毒；HHS = 嚴重高血糖加上高滲透壓；低血糖 = 低血糖伴隨自律神經或神經低血糖性發現。 為何此為正確 2024 年國際共識降低了 DKA 的血糖閾值，並強調直接測量 beta-hydroxybutyrate。DKA 可在血糖低於 200 mg/dL 時發生。HHS 的定義為高血糖和高滲透壓，且無嚴重酮血症或酸中毒；說 HHS 完全沒有酮體過於絕對，因為可能出現輕度酮血症。 NCLEX 決策規則 不要僅依血糖分類。將血糖、酮體、pH 或碳酸氫鹽、滲透壓、水合狀態和意識狀態一起判讀，並辨識可能的 DKA-HHS 混合表現。參考資料 1ADA/EASD/JBDS/AACE/DTS 高血糖急症共識報告Diabetes Care, 2024 ## 臨床情境 急症評估 使用目前的成人共識準則。DKA 與 HHS 可能重疊，且 HHS 可能包含輕度酮血症；依據最強烈的型態分類每項發現。 ## 重要概念 - **Beta-Hydroxybutyrate** — DKA 中主要的循環酮酸，也是首選的直接血液酮體測量指標。 - **高滲透壓** — 血液中滲透活性粒子濃度增加，為 HHS 的定義性特徵。 - **神經糖缺乏** — 腦部缺乏葡萄糖 — 低血糖造成意識混亂、抽搐、昏迷。 ## 相同主題題目 - [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=zh-tw) - [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=zh-tw) - [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=zh-tw) - [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=zh-tw) - [A 68-year-old client is admitted to the emergency department with suspected sepsis from a …](https://mymerci.kr/pages/nclex_q.php?qn_id=363987&lang=zh-tw) - [A nurse is caring for an adult client in the emergency department who is suspected to have…](https://mymerci.kr/pages/nclex_q.php?qn_id=363993&lang=zh-tw) - [A nurse is teaching a 72-year-old client with chronic heart failure (reduced ejection frac…](https://mymerci.kr/pages/nclex_q.php?qn_id=366202&lang=zh-tw) - [A nurse is caring for an adult client admitted with diabetic ketoacidosis. Laboratory resu…](https://mymerci.kr/pages/nclex_q.php?qn_id=366294&lang=zh-tw) ## 以其他語言閱讀 - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=393522&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=393522&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=393522&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=393522&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=393522&lang=vi) --- More free questions: [NCLEX-RN 題庫](https://mymerci.kr/pages/nclex_bank.php?lang=zh-tw) _僅供學習參考。實際臨床請遵循最新指引與所屬機構規範。_