Bartter’s误诊为甲状旁腺功能减退1例

Bartter's在临床少见,今报告由甲状腺全切后发生 Bartter's误诊为甲状旁腺功能减退Ⅰ例. 1病历摘要 患者,女,60岁,住院号7059.因反复呕吐7天入院.40 天前因患甲状腺癌行甲状腺全切,术后口服甲状腺素片替代 治疗.7天前出现心慌,手指麻木伴恶心、呕吐、腹泻、水样便, 对症处理无好转而收入院.查体:体温36.3℃,脉搏72次/ 分,呼吸18次/分,血压13.3/8Kpa,神志清,表情淡漠,中度 脱水,颈软,可见-5cm长手术疤痕.双肺心脏无异常,腹软, 无压痛及反跳痛,肝、脾未及,四肢肌张力低,chevostek征阳 性.Trousseau征阳性.实验室检查:血Na+130mmol/L、K+ 2.1mmol/L、cl-82mmol/L、ca++0.6mmol/L、Mg++ 1.6mmol/L、p+++1.1mmol/L、Co2-cp23.86mmol/L、 BUN3.97mmol/L、Cr97.98mmol/L、T3＜0.5ug/L、T427ug/ L.