糖尿病酮症酸中毒合并代谢性碱中毒一例报道

A case report of diabetic ketoacidosis complicated with metabolic alkalosis

报道1例82岁糖尿病患者,因"口干多饮多尿10余年,意识不清1d"入院,初步诊断为T2DM、DKA。予补液联合胰岛素纠正脱水,控制血糖,维持电解质平衡。患者随之出现代谢性碱中毒合并低氧血症。进一步完善检查后明确诊断为重症肺炎合并1型呼吸衰竭。予积极抗感染化痰、纠正低氧血症后,病情好转出院。DKA是内分泌科常见的急危重症,老年患者病情变化迅速,死亡率高。临床应明确DKA的诱因,避免漏诊及延误治疗,影响最终结局。

A 82-year-old patient with diabetes mellitus was admitted to hospital for "dry mouth, polyuria for more than 10years,unconsciousness for 1day " .She was initially diagnosed as type 2diabetes mellitus (T2DM)and diabetic ketoacidosis (DKA).We used fluid replacement combined with insulin to correct dehydration,control blood glucose and maintain electrolyte balance.However,metabolic alkalosis and hypoxemia were developed in the patient subsequently.After further examination,the patient was definitely diagnosed as severe pneumonia complicated with type 1respiratory failure.After anti-infection and expectorant treatment and hypoxemia,she recovered and was discharged from the hospital.Diabetic ketoacidosis is a common acute and severe disease in Department of Endocrinology.In elderly patients,the condition changes rapidly and the mortality rate is high.Therefore,particular attention should be paid in finding the cause of DKA to avoid missed diagnosis and delay of treatment,which may affect the final outcome of patients.